key: cord-0738099-l3wxg2lx authors: Ali, Majid; Allihyani, Moayad; Abdulaziz, Akrm; Alansari, Safwan; Faqeh, Sultan; Kurdi, Ahmad; Alhajjaji, Abdulrahman title: What just happened? Impact of on-campus activities suspension on learning during COVID-19 lockdown – Pharmacy students' perspective date: 2021-09-21 journal: Curr Pharm Teach Learn DOI: 10.1016/j.cptl.2020.09.014 sha: c9cbaf17f0dabe4aef3ff577ede3eae5b3ef5437 doc_id: 738099 cord_uid: l3wxg2lx INTRODUCTION: COVID-19 pandemic induced lockdown, suspending all on-campus educational activities in KSA, compelling to continue the education online. We explored pharmacy students' perspective on its impact on their learning. METHODS: A Twitter chat was organized on three consecutive days, after final examinations, inviting all pharmacy students in KSA to participate. Day 1 chat included 11 questions regarding learning and assessment, Day 2 chat included six questions about online examinations and six questions about technology use, Day 3 chat included six questions related to lessons learnt from the learning experiences during the lockdown. The questions were validated and piloted before the chat. The responses were copied, reviewed to remove any confidential information, and thematically analyzed by two teams of research students independently. RESULTS: During the three-day chat, 790 responses were received in total. Thematic analysis generated 944 codes which were categorized into 43 subthemes. These subthemes were further categorized into six main themes: ‘facilitators for online education’, ‘barriers for online education’, ‘online versus onsite education’, ‘role of technology in online education’, ‘suggestions for improving online education’ and ‘long-term impact of online education during lockdown’. Participants highlighted several facilitators and barriers which affected their education during the lockdown, compared online education with onsite education, and provided suggestions for improving online education based on their learning experiences during the lockdown. CONCLUSIONS: As COVID-19 pandemic and its repercussions are expected to last longer, pharmacy colleges and academic staff will find these findings useful to prepare for the coming years, ensuring pedagogical and accreditation standards. The coronavirus disease 2019 (COVID-19) originated from China in December 2019, 1 was declared a pandemic by World Health Organization on 11 th March 2020. 2 In the same month, Ministry of Education in the Kingdom of Saudi Arabia (KSA) suspended the physical attendance in all the educational institutes announcing the shift of all educational activities to online. 3 This was soon followed by the partial to complete lockdown in the majority of the cities in the KSA until after the end of the second semester of the academic year 2019-2020. This move to distance learning, or more precisely online learning, forced the educational institutes and the academic staff to readjust their teaching and assessment methods. Although distance learning or online learning has been around for decades, unfortunately, many institutes were not prepared for this unprecedented situation. Similar to the other healthcare education programs in higher education, the pharmacy education sector was also affected. Not all courses could be easily shifted to online. Both the academic staff and the students in the pharmacy had a very limited time to adjust their lifestyle as well as the educational activities. Challenging situations often lead to new and innovative ways. 4 Pharmacy educators around the KSA and worldwide capitalized on this extraordinary time to create opportunities for them. Several pharmacy courses and teaching and assessment methods were modified to best meet the learning outcomes and the students' best interests. Final examinations were also replaced by alternative assessments in some courses. Learning Management Systems (LMS) and online video-conferencing programs have never been explored and utilized to this extent before. Fortunately, the widespread availability of technology was leveraged to meet the challenges. The pandemic has indeed propelled us into the new era of 'out-of-the-box thinking and creative problem-solving' in the context of online education. 5 Online education is 'the method of content dissemination and rapid learning through the application of information technology'. 6 It has also been referred to as e-learning in the literature. Salter et al conducted a systematic review examining the effectiveness of e-learning in pharmacy education. They concluded from the 17 studies that e-learning in pharmacy education significantly improves knowledge. However, in comparison, they found e-learning to be as effective as traditional learning. 7 J o u r n a l P r e -p r o o f These results have been reported in concurrent with the effectiveness of e-learning in other healthcare professions. [8] [9] [10] [11] [12] Online education is not free from limitations. Lessons learnt from the online pharmacy education experience during the suspension of on-campus activities and/or the lockdown in this pandemic must not be wasted. Moreover, since the students experienced the direct impact of these drastic measures, it is imperative to explore their experiences and views. Gaining insight into the pharmacy students' experiences in this situation can help the pharmacy colleges and educators make informed decisions regarding educational transformation that is required, as the pandemic is expected to last longer and its repercussions will be felt for many years to come. This study aimed to explore the impact of the suspension of on-campus activities and the lockdown had on learning and assessment in pharmacy education in the KSA from the student perspective. This study adopted qualitative methodology, grounded in the constructivist paradigm, 13 and involved gathering participants' views and responses via Twitter chat. This study was reviewed and approved by the Institutional Review Board (IRB) of Umm Al-Qura University (KSA) (Approval number: HAPO-02-K-012-2020-06-400). All pharmacy students (BPharm or PharmD) from any private or government university in the KSA were invited to participate in the chat. The chat was hosted on Twitter which is one of the most widely used social media platforms, especially among the youngsters, in the KSA. 14, 15 language. Another experienced bilingual academic staff member reviewed this translation for accuracy. The research students piloted these questions with another three students, in both the languages. Minor adjustments in the wording of the questions were made. Plan: A specific Twitter account (@TChatResearch) was created for the purpose of hosting the chat and collecting the responses of the participants. Since the number of questions developed (n=29) was deemed too many for one Twitter chat, we planned to split the chat over three days. A one-hour Promotion: We announced and promoted the chat on the Twitter account three weeks before the chat days, followed by several reminders and retweets. We also requested several pharmacy Twitter accounts, popular among pharmacy students in the KSA, to retweet our announcements, promotions, and reminders. A 'participation information sheet' (comprising a summary of the study and other relevant information) and detailed 'instructions about how to participate in the chat' were prepared for the participants, in both the Arabic and the English languages, were tweeted five days and two days prior to the chat respectively on the Twitter account and retweeted by several other accounts. We also requested the participants not to identify any individual or specific incident during the chat in any way for confidentiality. The participants were asked to send their response(s) to the questions in a private message or as a direct message (DM) to the Twitter account if they had any concern about their Twitter handle or responses being seen by the other participants. Execution: During the chat, we posted the questions in both the languages, one question after every 5-10 minutes. The participants could respond in either of the languages. Two research students moderated the chat each day, probing the participants appropriately as required during the chat. Participants during the Twitter chat were also encouraged to 'like' (if they agreed) and/or probe the other participants' responses. Each day after the chat, we selected by draw and announced one winner from among the participants to receive a 100 Saudi Riyal bookstore voucher, as per the announcement we made in the promotion mentioned above. Preparation: After the chat, the responses were copied as a transcript for thematic analysis. We removed the respondents' identities for anonymity and also any confidential information from the responses that could be attributed to any particular individual or incident. We also planned to remove irrelevant responses and the responses of any participant whom we doubted to be a pharmacy student from the KSA, however, this was not required. Execution: Two teams of the research students were created for performing thematic analysis, using the inductive approach, of the qualitative data (participants' responses) independently. The data analysis process included familiarization with the data, generation of codes, categorization of codes into subthemes, and then categorization of subthemes into the themes. The two teams then met and resolved the variations through discussion. The research supervisor further reviewed and modified the codes, subthemes, and themes, following several discussions with the teams. Some similar subthemes as well as the themes were combined during the process. Since the questions were already grouped under specific topics, these topics provided 'a priori' subthemes further facilitating the process of thematic analysis. Additional subthemes were also identified from the generated codes. Over the three-day chat, we received a total of 790 responses to 29 questions. The total number of responses received for each topic is presented in Table 4 . The majority of the participants responded in the Arabic language and in the main thread (as opposed to responding as DM). For the purpose of analysis, the responses were not translated back into the English language in order to preserve the essence of the meaning and expression of the original language. However, the codes, subthemes, and themes were generated in the English language by the bilingual research students. Thematic analysis generated 944 codes which were categorized into 43 subthemes. These subthemes were further broadly categorized into six main themes: 'facilitators for online education during lockdown', 'barriers for online education during lockdown', 'online versus onsite education', 'role of technology in online education during lockdown', 'suggestions for improving online education' and 'long-term impact of online education during lockdown'. Some subthemes were categorized into more than one theme. These themes, with the number of associated subthemes and codes, are presented in Table 5 . Table J o Journal Pre-proof 6 shows specific student comments, translated from the Arabic language for the purpose of presentation in this table, supporting each of the themes. The main themes to which the majority of the codes and subthemes were associated, were 'facilitators for online education during lockdown' and 'barriers for online education during lockdown'. The recurring subthemes that were categorized as facilitators were: easier and frequent communication, more availability of time at home during the lockdown, students' technology skills, the support provided by the academic staff, and the time and money saved from not having to travel to the campus; and those that were categorized as barriers were: technology problems, lack of effective interaction with the academic staff, inappropriate teaching and assessment methods, unsuitable timing of rescheduled 'live' online lectures and examinations, and increased number of assessments. The subthemes, such as technical skills of the academic staff and rearrangement of marks distribution in the courses during the lockdown period, had mixed codes and were categorized as both the facilitators as well as the barriers. These themes and the other themes, with the corresponding subthemes, are presented in the Appendix and discussed in the next section. with the classmates about their coursework, 19 and we know that this online collaboration among the students enhances their learning achievement. 20 An important factor which might have contributed in this regard is more availability of time during the lockdown. The academic staff, during the lockdown period, might also have sufficient time at home to communicate with their learners which they may not have otherwise. Nevertheless, this experience should enlighten the academic staff with the importance of effective communication and its positive effect in promoting deep learning. Regarding the time, the majority of the participants also mentioned that they had ample spare time available at home during the lockdown that they were able to dedicate to their studies, and they regarded it as a facilitator for their online learning during the lockdown. The academic staff deal with the millennial generation of students, the majority of whom are already equipped with excellent technology skills. This facilitates online education to a great extent, which is dependent on technology. 21 The participants in our study also resonated with this aspect and mentioned that their technology skills assisted in attending the online lectures, accessing the resources, attempting the online examinations, and thus in the overall online learning. Student experience in online education is often shaped by the support they receive. 22 The participants in our study recognized that the support provided by the academic staff, such as instructions to use the online resources and feedback on the coursework, was another facilitator for their online learning. Some participants also highlighted that the time and the money saved, from not having to travel to the university campus during the lockdown period, were some of the other positive factors that accrued from online education during the lockdown period. This is similar to the findings from a survey by Almuraqab which reported that majority of the United Arab Emirates students believe that the distance learning saved time and efforts to reach the campus during the suspension of on-campus activities. issue and reported that this can adversely affect the learners' online learning experience. 25 Comer and Lenaghan, and Castle and McGuire have presented some recommendations to enhance the interactions and thus the learners' learning experience in online education. 26, 27 Other factors that affected participants' online learning were found to be inappropriate teaching and assessment methods, and unsuitable timing of rescheduled 'live' online lectures and examinations during the lockdown period. Online education shares some attributes with traditional education, however, it has some unique techniques that must be considered carefully by the academic staff in order to adapt their teaching and assessment methods. [28] [29] [30] [31] [32] Academic staff should also be more flexible regarding rescheduling the 'live' online lectures and examinations in order to provide relief to already stressed students in this unprecedented time. Some participants also commented that due to the sudden shift to online mode, there was a rearrangement of course assessments, which resulted in an increased number of assessments for the students in some courses, further increasing the pressure on them. The academic staff must reconsider the assessment strategies in an attempt to reduce the number of assessments without compromising the learning outcomes and pedagogical considerations. Some participants mentioned that 'cheating' or 18 In contrast, we also had some participants who found no significant difference between online and onsite learning. Berman articulated in the context of higher education "that teaching is both art and science" and that "good teaching is good teaching regardless of the learning environment or the subject to be explored". 34 The participants who preferred onsite education attributed it to their preference for the traditional face-to-face educational environment, which, in their view, is irreplaceable by the online educational environment, especially where the learning of more practical (including the laboratory work) and handon skills are required. Appana argued in a review encompassing the benefits and limitations of online learning that not all courses and teaching sessions are suitable for transforming into the distance or computer-based learning. 35 The participants also raised the concern that, although online education is safer during the pandemic, sitting in front of and focussing on electronic devices for more extended periods is not good for their health. Moreover, they found it difficult to maintain the concentration in the online lectures as compared to the onsite lectures. Although the role of technology has been covered above as a facilitator as well as a barrier, this theme included the participants' views about technology devices and electronic platforms used for their online learning during the lockdown period. The majority of the participants used tablets, laptops, and smartphones for their online learning. Smartphones and tablets were also found to be the most widely used devices by the students in Hamilton et al's survey in which the participants also added that they find these devices very valuable for their online learning. 19 The participants in our study also mentioned that these electronic devices are easier to use, suitable for online learning, portable, faster to work with, and helpful in storing and researching the stored or online resources. Blackboard was found to be the most widely used electronic platform, although some participants mentioned that the ZOOM application is better for online meetings. The participants found these technology devices and electronic platforms easier to navigate through due to their already existing technology skills and detailed instructions provided by the academic staff. However, the participants highlighted that some academic staff's knowledge and skills regarding these technology devices and electronic platforms were not up to the par, which negatively affected their learning experience. As it has been echoed before, the millennial generation of our students has higher expectations from the academic staff in this regard. Moreover, online teaching requires new teaching skills which, unfortunately, some academic staff are not currently prepared for. 27 Academic staff, therefore, must be well aware of the devices and platforms available and how they can be effectively used to maximize the online learning experience of the students. The most recurring aspect in the participant's responses regarding improving online learning experience was the provision of recorded lectures and the availability of recordings of 'live' lectures, J o u r n a l P r e -p r o o f which the students can refer to for revision of complex concepts. Although this is feasible for students and may result in higher student satisfaction, 36 the academic staff should be careful as this can negatively affect the student attendance in 'live' teaching sessions. 37 The second most commonly mentioned suggestion was for the academic staff to modify their teaching techniques for a better explanation of the complicated concepts in online pharmacy education. As it has been discussed before, the online venture is different from the traditional education, and the academic staff must adapt their teaching methods to better suit this medium. [28] [29] [30] [31] [32] Some participants, who seemed to be unsatisfied with the course marks distribution that had to be readjusted due to the suspension of oncampus activities, also suggested the academic staff reconsider this aspect in future online pharmacy education as this can have a crucial impact on their grade point average (GPA) and degree classification. Our findings are based on the pharmacy students' experiences of online education, which was enforced during the lockdown period due to the COVID-19 pandemic. Many pharmacy colleges and the academic staff were not prepared for this and were compelled to improvise their teaching and assessment. Also, the students in our study were only from the KSA where the regional and cultural differences might have impacted their experiences that shaped their views. Therefore, the opinions should be viewed with caution for the application of widescale transformation. Moreover, we could only find limited evidence from the literature to support our findings due to the unique nature of our study. Furthermore, our Twitter chat did not cover some other related topics such as the impact of lockdown on experiential learning (i.e. summer training, rotations, internship, etc.) in pharmacy education, the economic impact of lockdown on pharmacy education, and mental/cognitive impacts of lockdown on pharmacy students. These topics are open to being explored in future research. Distance education or online education has existed for decades. However, the COVID-19 pandemic has revived the need for it in every field of education, and in every part of the world. In our study, the pharmacy students, based on their pharmacy education experiences during the lockdown period, provided valuable views that have implications for transforming the future of pharmacy education, which has been proposed by them, to be a hybrid of online and onsite learning activities. Pharmacy colleges and the pharmacy academic staff around the world can find these findings useful to prepare for the coming years, ensuring the pedagogical and accreditation standards. Further research should provide an insight into how and to what extent pharmacy students' knowledge, skills, and attributes are affected due to the educational transformation during and post-pandemic. 6. About online education during the lockdown, did you have the opportunity to raise your voice (i.e. give suggestions and any feedback to the university and the university doctors, make complaints, etc.)? If YES, was your voice heard and acted upon? J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f WHO Coronavirus Disease (COVID-19) Dashboard Saudi Arabia suspends schools, universities over coronavirus fears Lessons learned and brighter opportunities for pharmacy education amid COVID-19 Pharmacy education crosses the Rubicon School's Out, But Class's On", the largest online education in the world today: Taking China's practical exploration during the COVID-19 epidemic prevention and control as an example. Best Evidence of Chinese Education Effectiveness of e-learning in pharmacy education Effective e-learning for health professionals and students barriers and their solutions. A systematic review of the literature-findings from the HeXL project Internet-based medical education: a realist review of what works, for whom and in what circumstances Instructional design variations in Internet-based learning for health professions education: A systematic review and meta-analysis Internet-based learning in the health professions: A meta-analysis Impact of e-learning on nurses' and student nurses knowledge, skills, and satisfaction: A systematic review and meta-analysis Emerging perspectives on learning, teaching, and technology Global Media Insight (GMI) Blog. Saudi Arabia social media statistics Intelligent analysis of Arabic tweets for detection of suspicious messages Communication dynamics: Discussion boards, weblogs and the development of communities of inquiry in online learning environments The social dimensions of online learning Students' perceptions of online learning and instructional tools: A qualitative study of undergraduate students use of online tools The role of online learning in pharmacy education: A nationwide survey of student pharmacists Student satisfaction, performance, and knowledge construction in online collaborative Shall universities at the UAE continue distance learning after the COVID-19 pandemic? Revealing students' perspective Best practices for use of blended learning Pedagogical characteristics of online and face-to-face classes Enhancing discussions in the asynchronous online classroom An analysis of student self-assessment of online, blended, and face-toface learning environments: Implications for sustainable education delivery Towards best practices in online learning and teaching in higher education A nursing faculty's transition to teaching online Learning in a Mega Open University: Faculty attitude, barriers and motivators The faculty -Instructional designer dyad Factors related to instructors' willingness to participate in distance education Online pedagogies and the promotion of "deep learning Good teaching is good teaching: A narrative review for effective medical educators A review of benefits and limitations of online learning in the context of the student, the instructor, and the tenured faculty Students' satisfaction and valuation of web-based lecture recording technologies Evaluating the use and impact of lecture recording in undergraduates: Evidence for distinct approaches by different groups of students About the online exams For the online exam For the online exam, do you think sufficient information was provided to you about how to attempt the exam? if there was no lockdown) (e.g. achieved more marks, easier, more time was allowed, took less time to finish, etc.)? electronic device (iPad, tablet, laptop or notebook, desktop computer, mobile phone Do you think your electronic device was appropriate for your online education? If YES, how? If NO, why? 3. Which education medium (blackboard, moodle, canvass, zoom, cisco webex, microsoft meeting, etc.) was used, majority of the time Do you think sufficient information was provided to you about how to use the education medium (blackboard, moodle, canvass, zoom, cisco webex, microsoft meeting, etc.) by the university or the university doctors? What just happened? Impact of on-campus activities suspension on learning during COVID-19 lockdown -Pharmacy students' perspective The authors acknowledge the academic staff and the students who helped translate, validate, and pilot the questions. The authors would also like to thank all the participants for their valuable opinions in the Twitter chat. Table 6 Student quotes supporting the themes Theme 1: Facilitators for online education during lockdown  "Yes, was easier especially when asking questions in chat"  "Don't require the presence of the student at the same town where the university is located and it saves time, effort and cost of transportation"  "Most of the doctors do a pilot exam for students to practice how to attempt online exams"  "I had more time because of staying at home all day. And lockdown gave me more time to study"  "Electronic assignments led me to acquire new skills"  "Yes, honestly thanks to faculty members and supervisors, they clarified everything by sending the instruction in all applications"  "Distribution of marks was appropriate because learning outcome not measured only by exams but also by other semester activity"Theme 2: Barriers for online education during lockdown  "Interaction is not the same"  "Bad internet connection"  "Not suitable lecture and study timing was a major factor in my not doing well in this semester"  "Most of the practicals require to be in lab"  "Online exams made it easier to ask the help of colleagues or copy answers from different websites"  "The disadvantage was not understanding the lectures clearly and assignments were too many"  "Lack of discussion and share of information between colleagues during the lectures"  "Online is not good and comfortable, onsite was better due to the quiet environment"  "I can go through assignments onsite with faculty members and understand the instructions but in online I can't discuss with doctor appropriately and find out where my missed points are"  "Online exam environment is very comfortable"  "The advantage was that there was enough time to attempt the online exam, without any anxiety or stress which led to high marks as compared to the onsite exam"Theme 4: Role of technology in online education during lockdown  "I used iPad or laptop most of the times"  "Electronic exam was good, it reduced time when you are writing in your exam"  "Blackboard was good but sometimes problems with audio occurred and required specific application to correct the problem"  "Calls and social apps were distractions when using the phone"  "Usually used iPad because easy to handle and take anywhere" Theme 5: Suggestions for improving online education  "Some doctors, but not all, I think need technical skills courses"  "Video record the lectures to make them easily accessible at any time"  "Reduce the marks for assignments and increase the marks for the exam, there was too much content in the exam"Theme 6: Long-term impact of online education  "Positive effect, most students get high grades"  "New skills I learned in the time of distance learning"  "Lack of presentation skills and it should be in front of the audience to acquire this skill" J o u r n a l P r e -p r o o f Author contributions:MA designed the study. All authors were involved in data collection, analysis, and interpretation, and contributed to the drafting and critical review of the manuscript. All authors approved the final draft of the manuscript.