key: cord-0726036-us5fs6kt
authors: Dehghanpour, Mahsa; Baker, Jamie
title: The Impact of COVID-19 on Medical Dosimetry Education: Students’ Perception on the Effectiveness of Program's Immediate Response
date: 2021-11-27
journal: Med Dosim
DOI: 10.1016/j.meddos.2021.11.001
sha: 56a9dcff4659c8bca018d779964fe520c331e5e6
doc_id: 726036
cord_uid: us5fs6kt

In early 2020, many medical dosimetry programs began to offer lectures and clinical rotations remotely in response to COVID-19. Faculty instituted an IRB-approved study to investigate the effectiveness of medical dosimetry educational programs’ immediate response to COVID-19 and modifications to teaching practices during the pandemic. The Program Response to COVID-19 Effectiveness Questionnaire (PRCEQ) survey was developed to measure students’ perceptions of their learning experience during COVID-19. The subject of the study was the medical dosimetry current and former student population who received modified education delivery during the COVID-19 pandemic. This study suggests that generally students are satisfied with the quality of their virtual didactic and clinical education as well as communication between faculty and students and students to students. Programs should develop strategies to engage students during the virtual classes to motivate them to learn; utilize a variety of formats for the evaluation of students’ learning, incorporate activities to help students make connections with real-world clinical situations, and schedule clinical visits for students to learn tasks that require their physical presence in clinic.

Study Title: The Impact of COVID-19 on Medical Dosimetry Education: Students' Perception on the Effectiveness of Program's Immediate Response

In early 2020, many medical dosimetry programs began to offer lectures and clinical rotations remotely in response to COVID-19. Faculty instituted an IRB-approved study to investigate the effectiveness of medical dosimetry educational programs' immediate response to COVID-19 and modifications to teaching practices during the pandemic. The Program Response to COVID-19 Effectiveness Questionnaire (PRCEQ) survey was developed to measure students' perceptions of their learning experience during COVID-19. The subject of the study was the medical dosimetry current and former student population who received modified education delivery during the COVID-19 pandemic. This study suggests that generally students are satisfied with the quality of their virtual didactic and clinical education as well as communication between faculty and students and students to students. Programs should develop strategies to engage students during the virtual classes to motivate them to learn; utilize a variety of formats for the evaluation of students' learning, incorporate activities to help students make connections with real-world clinical situations, and schedule clinical visits for students to learn tasks that require their physical presence in clinic.

Medical Dosimetry educational programs include didactic and clinical education. During their education, medical dosimetry students gain knowledge in radiation physics, cross sectional anatomy, radiation biology, and other science-related disciplines to apply in their clinical rotations. The COVID-19 pandemic impacted the United States in early 2020, and many universities began offering their curriculum remotely. Many medical dosimetry programs started to offer didactic and/or clinical education online in response to the COVID-19 pandemic. The purpose of this IRB-approved study is to identify students' perceptions of the effectiveness of their medical dosimetry programs' responses to COVID-19 and to discuss potential strategies to improve didactic and clinical education as well as communication among students and between students and faculty in medical dosimetry education when the modified education delivery is utilized.

The Program Response to COVID-19 Effectiveness Questionnaire (PRCEQ) measures students' perceptions of their learning experience during the COVID-19 pandemic. The subject of the study is the medical dosimetry current and former student population who received modified education delivery due to the COVID-19 pandemic. The PRCEQ questionnaire measures the students' assessment of 1) instructional quality in didactic education; 2) instructional quality in clinical education; 3) opportunities for and quality of interaction with faculty; 4) opportunities for and quality of interaction with peers; and 5) aspects of the medical dosimetry education and communication that have been particularly positive or negative and suggestions for improvement.

COVID-19 forced universities to pivot from a traditional or hybrid format to a strictly online method to deliver didactic content and laboratory activities. The abrupt move to online instruction has resulted in increased costs and decreased revenue sources. 1 COVID-19 challenges higher education administrators and faculty to maintain normal operations while adjusting to novel demands concerning admissions, campus safety, and online learning. 2 In addition to the administrative burden on university leadership, classroom and clinical instructors interact with students who are impacted emotionally and psychologically by the ill effects of COVID-19. 3 The response of higher education institutions to COVID-19 included a rapid shift to online teaching, and colleges and universities dealt with the changes in varying ways. Quinn et al. investigated the immediate response of European dental universities to COVID-19. 4 Clinical activities of dental students were sharply curtailed during 2020, and classes were moved to online. 4 Rajhans et al. studied how the system of optometry higher education has responded to disruptions caused by COVID-19. 5 

The sample for this study included current or former students of JRCERT-accredited medical dosimetry programs who experienced a modified education delivery since March 2020 due to COVID-19 pandemic. The Joint Review Committee on Education in Radiologic Technology (JRCERT) is the only agency for accreditation of educational programs in medical dosimetry. After the pilot survey was completed and the PRCEQ was finalized, an email was sent to all JRCERT-accredited medical dosimetry program directors with a link to the survey on Qualtrics. The researchers asked the program directors to forward that email to all of their students and former students who have been studying in the medical dosimetry program since March 2020. An estimated 135 current and former students of JRCERT-accredited medical dosimetry programs who studied in the program since March 2020 were invited to complete the survey. The emailed invitation contained the purpose of the study, informed consent disclosure, and a link to the survey. After reading the informed consent disclosure, the participants could decide if they wanted to complete the survey by clicking on the link in the email. When the survey opened, the participants also had to select "yes" to begin the survey. If the participants clicked "no," the survey would close.

The survey link was active for one month, and after that time period, the survey was closed. Results were exported from Qualtrics to Excel, and the quantitative data were analyzed.

The qualitative written responses were evaluated to identify patterns and themes. The raw data and output tables are stored on a password-protected institutional computer and can only be accessed by the investigators. All data is stored behind the institutional firewall. The data were aggregated, and results are reported in a manner that no medical dosimetry program can be tied to a specific result.

Eight out of 17 JRCERT-accredited medical dosimetry programs participated in this study. The program directors sent the survey questionnaire to a total of 135 students and graduates who received their education during the pandemic. The Qualtrics system received 51 responses from January 11 th to February 12 th , 2021. Responses with at least one answer to the 27 items were considered valid. There were 51 valid responses that were included in the data analysis, which demonstrates a 37.8% response rate for the survey. The distribution of credentials among respondents included 33% certificate, 55% Bachelor of Science or Bachelor of Arts, and 12% Master of Science. The respondents included 31% male and 65% female. 4% of the respondents preferred not to answer the question concerning gender. 

The first category in the PRCEQ survey involved medical dosimetry students' and graduates' perceptions about their medical dosimetry program's response to COVID-19 as it relates to their didactic education. 73% of respondents indicated that their didactic education was affected during the pandemic and became either fully remote (45%) or a mix of remote and in person (28%). 27% of respondents indicated that their didactic education was not affected because they were already offered remotely (23%) or continued to be face-to-face (4%). The participants' responses about their satisfaction with their didactic education were divided into "satisfied" and "unsatisfied." The responses of "very satisfied" and "satisfied" were coded as "satisfied," while the answer choices of "unsatisfied" and "very unsatisfied" were interpreted as "unsatisfied." 96% of respondents were satisfied with their program's response to COVID-19 in terms of didactic education, and 80% were satisfied with learning didactic material in the new delivery format. When asked about their learning experience during the pandemic compared to prepandemic, we coded the answer choices of slightly or significantly declined as "declined" and slightly or significantly improved as "improved." 49% of respondents felt that their learning experience was equivalent to pre-COVID-19 while 16% felt an improvement and 36% felt a decline. When asked about the level of clinical learning during the pandemic compared to prepandemic, 51% indicated an equivalent clinical learning experience, 2% indicated an improvement and 47% indicated a decline.

When asked about the positive aspects of the remote clinical education, the top three responses were remote access to treatment planning creating a time flexibility to practice, independence in learning, and less stress due to not having to commute. When asked about the negative aspects of the remote clinical education, the top three responses were lack of interaction with radiation oncology team members except mentors, not being able to participate in all dosimetry related activities and inability to do certain tasks requiring their presence in clinic. Total 100%

Participants were asked open ended questions about the positive and negative aspects of their didactic education during the pandemic. The most cited positive aspects included time flexibility, ability to watch recorded lectures, high level of communication with peers and mentors, and reduced commute. The most cited negative aspects included internet and connectivity issues, which particularly make the test taking stressful; not being able to ask questions and clarify concepts in person; instructors' lack of familiarity with the virtual learning;

and reduced students' personal motivation and participation in didactic classes.

Participants were asked open ended questions about the positive and negative aspects of their clinical education during the pandemic. The most cited positive aspects included remote access to treatment planning software, more time to practice, working at one's own pace, learning independently, time flexibility, save time on commute, the ability to work with multiple dosimetrists, and preparation for the future remote work. The most cited negative aspects included lack of patient interaction, less clinical time, inability to perform certain clinical activities requiring a physical presence, missing out on hospital staff discussions and clinical scenarios, wasting time due to waiting for the mentors to be available to teach or answer questions, not being able to see real life examples, less likely to see rare procedures, low patient load, no "safe" space to work in a small house, lack of motivation during on-line sessions, computer issues, and not seeing the clinical environment making it difficult to relate ideas to real situations.

The vast majority of respondents were satisfied with their program's response to COVID-19 in terms of didactic education and were satisfied with their level of learning. However, about one-third of respondents experienced a decline in their didactic learning experience.

Incorporating innovative teaching strategies improve students' learning outcomes. One strategy is to mimic a face-to -face classroom in a virtual environment by conducting synchronous lectures; utilizing webcams to visually connect with students; engaging students during the virtual classes by asking questions; using the polling options to encourage participation; utilizing break out rooms to encourage small group discussions; and using portable document cameras to year while utilizing webcams and share some personal information about hobbies, pets, and family as well as providing time for students to introduce themselves. Fun activities can be conducted by faculty to help students get to know each other better.

The vast majority of respondents indicated that communication was great among the students; they used MS Teams, Zoom, Group Me and other platforms. Some suggestions for improvement included providing a platform for students to communicate to one another, scheduling time for a regular communication between students, and suggesting students to communicate more. Program directors can incorporate regular students' communication time on the calendar and suggest a platform to encourage and assist students' communication. This helps students who are shy and do not regularly take part in communication with the class and is helpful at the beginning of the school years when students do not know each other well.

The limitation of this study is related to the sample size. About half of the medical dosimetry programs across the United States did not participate in this study (53%) and the number of students and graduates from each program who responded to the questionnaire was limited. Higher participation would have captured a richer data that could be generalized.

COVID-19 brought challenges to educational programs across the nation. The health sciences programs faced an additional challenge due to the clinical component of their programs.

Many of the medical dosimetrists were asked to work from home and students were not allowed in clinic. Many of the medical dosimetry programs offered their education virtually by utilizing technology and providing students with remote access to treatment planning software.

This study suggests that generally students are satisfied with the quality of their virtual didactic and clinical education as well as communication between faculty and students and students to students. They found time flexibility, independence in learning, and reduced commute as benefits of their virtual education. Programs should develop strategies to engage

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