key: cord-0845544-8slppkno authors: Lee, Su-Jin; Park, Jayoung; Lee, Yoon Jung; Lee, Sira; Kim, Woong-Han; Yoon, Hyun Bae title: The feasibility and satisfaction of an online global health education course at a single medical school: a retrospective study date: 2020-11-30 journal: Korean J Med Educ DOI: 10.3946/kjme.2020.178 sha: fb3d5183114f46ec67d5cbe800d2dd4fe8d5e489 doc_id: 845544 cord_uid: 8slppkno PURPOSE: The aim of this study was to evaluate the feasibility and satisfaction of an online global health education course for medical students in comparison with an in-person of the course and to assess students’ preferences regarding online methods of delivery. METHODS: Second-year medical students enrolled in this course in 2019 (in-person) and 2020 (online). The attendance rate, satisfaction in the course evaluation survey, and academic achievement on the written final examination were utilized to compare the two different methods of course delivery. The medical students who took the online course were also asked about their preferences regarding the method of course delivery and the advantages and drawbacks of each method of online lectures. RESULTS: There was no significant difference in the attendance rate and overall satisfaction between the two groups. The mean score on the written examination of the online course (84.1±19.6) showed comparable effects to the in-person course (78.0±18.3). The percentages of students who achieved high performance (55.5%) and the achieved minimum requirement (95.9%) were also maintained compared to the in-person course (14.6% and 93.6%, respectively). Medical students preferred the online course to the in-person course; in particular, they preferred prerecorded videos over live streaming online lectures. CONCLUSION: The participation, satisfaction, and the academic achievement of the online course were comparable to those of the in-person course. However, the greatest drawback of the online course was the lack of interaction between peer learners. Therefore, diverse methods for online education should be considered to increase students’ sense of belonging to a learning community. In the era of globalization, doctors need to have a broad knowledge of tropical diseases and global health issues, as well as expertise related to general medical practice [1] . Thus, professional education on global health and its related systems is becoming a priority in medical schools' curricula [2] . [4] . The spread of COVID-19 has made it necessary to develop and implement online lectures. The medical education has also prompted changes, as coursework was rapidly developed to be delivered through free online platforms using high-tech methods and online lectures, including key clinical conditions, case studies, and examination questions. These new methods are wellaccepted by medical students who can access the lectures easily, as lectures can be repeated as needed [5] . Medical schools have also promptly developed online lectures worldwide, using various online platforms such as Zoom [5] . Egypt's medical schools have implemented teambased learning using Zoom's breakout room function [5] . However, the spread of COVID-19 is not the only factor contributing to the introduction of online education in medical schools. In particular, the online learning is considered an effective pedagogical method for global health education due to its perceived interactivity and multimedia approach [6] . For efficient online education, several factors can be considered to promote the advancement of medical education through online global health instruction. For online education to ensure autonomous learning and to prevent gaps in individual learners' technological skills and various environments [7] , software systems and learning structures that are more sophisticated and systematic than existing face-to-face education must be developed and established. In addition, reflection activities, learning attitudes, and motivation should be improved through the promotion of active interactions with peer learners on various online platforms [8] . Students were deemed to have reached the minimum requirement when a 60% was attained, and as having achieved high performance when they received a score of 90% or more. We surveyed the medical students who attended the online course in 2020 regarding whether they preferred in-person or online courses, using ratings of "strongly preferred," "preferred," and "no difference." Similarly, students were asked about whether they preferred prerecorded lectures or live streaming online lectures, and they rated their preferences in the same way. and difficulty in self-directed learning. The medical students responded to these questions with options of "very unlikely," "unlikely," "neutral," "likely," and "very likely." Responses of "very likely" and "likely" were categorized as "agree," while those of "very unlikely," "unlikely," and "neutral" were categorized as "disagree." The collected data were statistically analyzed using IBM SPSS for Windows ver. 25.0 (IBM Corp., Armonk, NY, USA). The medical students' average attendance rate, overall satisfaction with the lecture, and written test scores were compared and tested with the independent t-test. The percentages of students who achieved for high performance and the minimum requirement were compared in both years. The percentages of preferences regarding methods of course delivery and the satisfaction of the medical students who took the online course, as well as their perceived advantages and drawbacks, were also analyzed. In 2019, 157 second-year medical students took the global health course, and 146 students did so in 2020. No significant differences were found between the students who took the course in 2019 and those who took the course in 2020 in terms of overall satisfaction, the presentation of educational goals, the organic connection between lectures, and whether the number of lectures was appropriate (Table 2 ). The mean score on the written examination was 78.0±18.3 in 2019 and 84.1±19.6 in 2020, reflecting a significant difference (t=-2.8, p=0.005). The percentages of students who achieved the minimum requirement (95.9%) and high performance (55.5%) in 2020 were numerically higher than those who did so in 2019 (93.6% and 14.6%, respectively) (Table 3) . The medical students who took online lectures in 2020 stated that they preferred online lectures (74.0%) over in-person lectures (16.4%). Additionally, they preferred prerecorded video lectures (56.2%) over live streaming online lectures (37.0%) ( Table 4 ). (Table 5 ). The scope of medical education must be established through discussions with specialized academic organizations, such as academic societies dedicated to medical education, and various stakeholders related to global health, innovate independently each medical school independently developing its related curriculum [9] . In Researchers at a medical school in Canada compared medical students' changes in knowledge and the feasibility and satisfaction of e-learning modules by randomly assigning students to either an e-learning group or a PDF article reading group to improve students' conceptual global health knowledge [6] . Another study confirmed the feasibility of online learning and evaluated intercultural peer learning through online collaborative group activities of medical students in Australia and Indonesia [10] . In our study, the participation, satisfaction, and academic achievement levels of medical students in the online global health education course had comparable results to the in-person education course. Another study referred to "ease of access" as a facilitator for e-learning [6, 7] , as e-learning is free from time and space constraints; this has been cited as the most important advantage of online education [11] . Medical schools' curricula must deliver vast medical knowledge and skills within limited time, and the location of classes may vary between classrooms, medical practice rooms, and the hospital [11] . Regarding this issue, online classes can save time and are effective in terms of educational costs, as it is easy to secure online space for education [7] . Medical students who took the global health education in 2020 preferred online courses over in-person courses, due to the former's greater flexibility, the easily understandable content of classes with materials that could be repeated, and the possibility of self-directed learning and taking classes according to one's individual conditions and pace. Several studies support these findings [12, 13] . Another study noted that students felt familiar with the use and accessibility of online education [14] . Among In a study of Hranstinski [15] , the real-time video and sound of the lecture were combined to enable the students to feel as though they were taking the lecture in the classroom, which enhanced interactions through the effective exchange of information and opinions among participants. Live streaming online lectures foster an environment in which collaboration and cooperation can be effectively achieved for learners who require team-based learning [16] . Despite the advantages of online education, its most significant drawback in this study was found to be the lack of interaction with peer learners. Several other drawbacks were cited, such as individual environments where students experience greater difficulty concentrating than in a classroom, a lack of interaction with professors, and difficulty in maintaining self-directed learning. Online education allows students to acquire medical knowledge without time or space constraints. However, it has a limited ability to create and support an effective collaborative learning community with personal encounters, due to the lack of potential learning opportunities [10, 17] , and a sense of belonging, the defining characteristic of a learning community [18] . Considering that other shortcomings can be overcome with technical development, the way of adapting online education to foster community should be carefully considered as a direction for medical education in the post-COVID-19, to promote exchange among peer learners and a sense of learning community. The limitations of this study are as follows. First, as this study targeted a specific grade level at one medical, the generalizability of the results of this study to all medical students is limited. Second, in comparing the written final exams score of 2019 and 2020, we were not able to conduct an analysis of the 2-year test items. Therefore, we should be careful to conclude that online education shows better results than in-person education in terms of academic achievement. 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