COVID-19, a global pandemic declared by the WHO on March 11, 2020, has led our entire country to an intense period of change and adaptation in all sectors
Online learning is a method to teach students using interactive information and communication technology in either a synchronous or asynchronous mode
Although online mode is considered efficient for theoretical teaching, it can be challenging when it comes to clinical training as it demands direct observation and hands-on exposure to clients. These factors may pose further challenge to the educators when it comes to ensuring the overall quality of education. Several studies have been conducted over the past two years to explore the efficacy of online clinical training and student perspectives towards it across many medical and allied health fields in different countries. Mixed opinions exist on the efficacy of online learning. Medical students preferred a combined approach of teaching as online learning of clinical medical skills was more challenging
Speech and hearing is one of the many allied health sciences. Speech language pathologists and Audiologists are involved in providing a range of clinical services like preventive, diagnostic and rehabilitative services to individuals with communication disorders. They may also be actively involved in research and development. Their educational preparation is highly skill-based, and necessitates a great deal of patient handling including vital skills such as active listening, empathy, and effective communication. This was traditionally being accomplished by practically oriented class based lectures and clinical exposure. However, due to the ongoing pandemic, there has been an abrupt shift of teaching-learning modality to online mode. Thus striking a balance between the clinical skill development and patient handling has become a challenge. Although, online mode of clinical training has been adopted, little is known about its impact on students. Lately, studies have been conducted to determine the student-faculty perspectives on online learning for theoretical classes but with only a few probing into online clinical training
This was a cross sectional survey study done using a Google Form of 19 questions, designed and validated by a team of faculty members at a Medical College in Mangalore. The study was carried out after obtaining necessary clearance from the scientific and ethical committee of the Institution.
A total 297 students in the age range of 18-25 years pursuing Bachelors in Audiology and Speech Language Pathology (BASLP) from institutions based in Karnataka and those approved by the Rehabilitation Council of India took part in the study. Students were only included if they had good internet connectivity for online clinical training.
The study was carried out in three phases:
A detailed survey questionnaire focussing on the most likely and common factors that contribute and affect the online clinical training program in terms of learning was formulated using literature review. It was divided into 2 sections. The first section covered the student demographics (age, gender, year of study etc.). The second section consisted of 19 binary choice questions related to teaching efficacy, overall limitations, and student learning satisfaction during online clinical training during the COVID-19 pandemic as well as their future perspectives towards online clinical training.
The developed questionnaire was validated by five experienced speech and hearing professionals with minimum 5 years of teaching experience to enhance the study quality. Based on their feedback, necessary modifications and revisions were made to enable better comprehensibility and sequencing of questions.
The finalized questionnaire (Appendix 1) was converted into a ‘Google form’ and was sent to students who met the inclusion criteria through online platforms such as WhatsApp and Gmail. Students were first given information about the content and purpose of the study and an informed consent was obtained. They were requested to provide authentic responses to the binary choice questionnaire based on their perceptions.
The collected data was statistically analysed using SPSS 20.0 software. Percentage analysis and descriptive statistics were used to get inferences.
The study was conducted on students pursuing Bachelors in Audiology and Speech Language Pathology (BASLP) from institutions based in Karnataka and approved by the Rehabilitation Council of India. The demographics are shown in
|
|
|
|
Male |
41 (13.8%) |
|
Female |
256 (86.2%) |
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Total |
297 (100%) |
Based on students’ perceptions regarding teaching efficacy during online clinical learning, 61.3% agreed that clinical faculty tend to focus more on theory rather than practical during online clinical training. Only 31.6% of the students were of the opinion that online clinical training is well structured whereas the other 68.4% did not agree with the same.
Furthermore, about 77.8% reported a lack of student - teacher interaction during online clinical training. A large percentage of students (79.1%) believed that for an optimal learning experience, supervision during online clinical training cannot be compensated.
While 36.4% reported that online clinical training provides access to variety of clinical resources/materials, 63.6% reported otherwise.
The study shows that a large percentage of students (93.6%) believed that the COVID-19 crisis has negatively impacted their clinical skills with 99% of them affirming that the COVID crisis has affected the clinical training more than the theory. Overall, only 7.7% felt that offline clinical training is better than online training.
Regarding the overall limitations of online mode of clinical learning, a similar proportion of the students reported a lack of exposure towards instruments used for assessment and management of speech, language, and hearing disorders and a lack of exposure to patients with online clinical training i.e., 97% and 96% respectively.
Based on students’ perspectives, learning satisfaction through online mode of clinical training was rather low as 77.8% reported a lack of learning satisfaction through online clinical training. Additionally, more than half of the students (59.6%) felt demotivated to attend online clinical training, while the remaining 40.4% reported otherwise.
Out of the 297 students who participated in the study, 67% support uploading pre-recorded demonstration videos of assessment and rehabilitation procedures for higher learning outcome and around 60.9% believed that clinical faculty performing the test in the testing room and students watching live gave output similar to that of offline clinical learning.
According to the participating students, online clinical training provides insufficient time to grasp the clinical concepts and clear queries (65.3%) and is likely to result in a lack of clinical handling skills development (94.9%). Moreover, only a small proportion (16.5%) predicted to feel confident post online clinical training, to handle the clinical population in the future.
Regarding future preferences, a majority of the students (90.2%) preferred to take additional offline clinical training after the COVID-19 crisis. While 53.5% preferred not to have online clinical training during the COVID-19 crisis, 46.5% were of the opinion that having online clinical training during the crisis would be beneficial.
Focusing on the global crisis COVID-19 virus, the current study was designed to explore perceptions towards online clinical training among BASLP students of Karnataka, India. In our study, we specifically evaluate student’s opinions toward teaching efficacy, overall limitations, learning outcome/satisfaction during online clinical training as well as their future recommendations for quality enhancement.
To summarise, our study results indicate that majority of the students felt that online clinical training is not well structured. This is in accordance with findings from previous studies
Over 60% of the students agreed that clinical faculty tend to focus more on theory rather than practical during online clinical training. However, for successful implementation of the online clinical training, instead of focusing only on theoretical aspects, the faculty must design meaningful learning activities based on authentic cases as much as possible. Case based learning would allow the students to effectively apply their theoretical knowledge to diagnose or treat the patients.
Moreover, our study results show that for an optimal learning experience, supervision during online clinical training cannot be compensated. While asynchronous modalities (in which faculty are not present in real-time) may permit more flexibility in thinking and response time, temporal presence of a faculty would facilitate students to clear doubts and receive timely feedback.
In a study carried out on Polish medical students, easy access to educational material was one of the strongest advantages of online learning, however our study results were contradictory
Our study shows that COVID-19 pandemic has had a negative impact on students’ clinical skills with a majority affirming clinical training being affected more than the theory. Similar findings have been obtained in earlier studies
Overall, only 7.7% felt that offline clinical training is better than online training. This finding is supported by Kumar
Additionally, a lack of exposure towards instruments used for assessment and management of speech, language, and hearing disorders and a lack of exposure to patients was reported as major limitations of online clinical training. This finding is consistent with other recently published studies assessing students’ perception of online classes during the pandemic
Our study reports students’ clinical learning experience through online mode as unsatisfactory. Furthermore, more than half of the students (59.6%) felt demotivated to attend online clinical training. These findings are in accordance with a recent study done by Stoehr et al.,
The students who participated in our study support uploading pre-recorded demonstration videos of assessment and rehabilitation procedures for higher learning outcomes and also believe that clinical faculty performing the test in the testing room and students watching live gives output similar to that of offline clinical learning. The delivery of online clinical training with either synchronous or asynchronous mode has its own merits and demerits. It would be ideal if the training curriculum includes a mixture of both the types of modalities for better learning.
According to our study, online clinical training provides insufficient time to grasp the clinical concepts and clear queries which is in conformity with findings from Dost et al.,
Moreover, students in our study believe that online clinical training will result in a lack of clinical handling skills development and only a small proportion of students predict feeling confident post online clinical training to handle the clinical population in the future. These findings are consistent with students’ opinion in many countries like Pakistan, China, Malaysia etc. To overcome these fears, the administration and faculty must take necessary measures and come up with innovative solutions to overcome the drawbacks of online clinical training.
Regarding future perspectives, about half the participating students preferred not to have online clinical training during the COVID-19 crisis and a majority of the students preferred to take additional offline clinical training after the COVID-19 crisis. This inclination points out to the students’ anxiety and fear that the crisis would have a detrimental impact on their clinical skills. Moreover, it shows their concern for future career opportunities. It is likely that these student behaviours will reduce if the administration focuses on implementation a curriculum framework of online learning that follows a mixed or blended approach combining both offline and online learning teaching modalities
Ours was an online based survey study set up to investigate BASLP students from institutions across Karnataka only, and results could have been completely different if the survey was conducted across other Indian cities. Future research could include those cities in order to get deeper insights about online clinical training. Furthermore, ours was a cross-sectional study which does not provide a holistic picture of the scenario. Thus, as a shortcoming, our findings may not accurately represent students’ perception of online clinical learning. To assess these effects, additional longitudinal studies may be required. Moreover, since this survey, mainly focused on students’ perceptions towards online clinical training, further research focusing on effectiveness and psychological impact may be required to understand the influence of online clinical training on students in more depth. Further studies could also investigate factors influencing student perceptions towards online learning and faculty’s attitudes and experiences towards online clinical training.
Although online clinical training has enabled continuation of speech and hearing education during the COVID-19 crisis, students in our study show negative perceptions towards online clinical training. They preferred offline mode over online mode as they feared missing the practical skills because these skills could not be compensated by online learning techniques. In order to overcome the current pitfalls and maximise the student learning outcomes in future we suggest speech and hearing administration and faculty to take necessary measures such as combining synchronous and asynchronous modes, creating virtual cases, and facilitating a team and case-based approach when conducting online clinical training.
The authors have no conflicts of interest to declare.