View of Impact of the COVID-19 Pandemic on Radiography Education from the Perspectives of Students: A Survey on Medical Imaging Students UniSZA

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https://doi.org/10.37231/ajmb.2023.1.S.679 https://journal.unisza.edu.my/ajmb

Impact of the COVID-19 Pandemic on Medical Imaging Education from Student’s Perspectives: A survey on Medical Imaging student UniSZA

Nurfatihah Abd Salam, Fairuz Mohd Nasir^*, Azlinawati Ali

Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kampus Gong Badak, 21300 Kuala Nerus, Terengganu, Malaysia

Corresponding author: [email protected]

Received: 1^stAugust 2023 Accepted: 10^th November 2023 Published: 24^th December 2023

Abstract

The Covid-19 pandemic has caused many changes in the norms of daily life and affected various fields as well as industries. One of the areas affected by this pandemic is education. Due to the limitation of physical meetings, while avoiding the spread of the virus, learning and teaching activities have changed from physical learning to online learning. Medical imaging education is also affected where students have to learn theoretical and practical courses virtually. Medical imaging education involves learning to position patients and operate medical imaging equipment, so it's challenging to learn online. Therefore, this study was conducted to see the impact of the pandemic on radiography education from the students' perspective.

The survey was performed among UniSZA medical imaging students who have undergone theoretical learning and clinical training within the period from March 2020 to March 2022. The survey was done by distributing an online questionnaire through Google Forms. The questionnaire consists of four parts;

demographic, perspective on theoretical learning during the pandemic, perspective on clinical training during the pandemic and challenges experienced in online/virtual learning. A total of 55 students participated in this study and the responses were analyzed using descriptive statistics. The result shows the majority of the students (54.55%) agree that learning basic radiography subjects through online learning during a pandemic is hard to focus on. From the perspective of clinical training during the pandemic period, the majority of students (56.63%) worried about being infected with the Covid-19 virus as this could interrupt the clinical training sessions. The majority of the students (41.82%) experienced difficulty with internet connectivity and inadequate time for online discussion during the online learning within the pandemic period. In conclusion, the Covid-19 pandemic has highly impacted learning activities for medical imaging students at UniSZA.

Keywords

Radiography education, Covid-19 pandemic, theoretical learning, radiography clinical training.

Introduction

The Covid-19 outbreak has had a profound effect on everyone and has changed daily norms. The Covid-19 virus easily infects others through droplets from the nose or mouth of a patient infected with the virus ^[1]. Therefore, at the beginning of the pandemic, to prevent the disease from spreading, a lockdown was

Asian Journal of Medicine and Biomedicine

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introduced. Lockdown has changed the norms in daily life including the education process. During the shutdown all educational institutions were closed and all teaching and learning activities began to switch to online. The closure of the university also caused many activities to be disrupted. The outbreak reduced the work effectiveness of half of the researchers, citing a lack of communication with team members, difficulty discussing ideas with team members, and data collection issues. During the outbreak, students experienced challenges such as data collection and lack of supervision from research supervisors ^[2]. Students in the field of radiography are also affected by this problem. Basically, teaching and learning in radiography involve theoretical learning, basic hands-on skills in the patient position and clinical training in the hospital. Theoretical learning includes theoretical courses such as instrumentation and radiation physics, practical learning involves hands-on practical positioning of patients while clinical training involves clinical placement in a hospital. Studying theoretical subjects online may be easier than learning 'hands-on' virtually.Some courses involve skill learning on radiographic techniques where it is appropriate to be carried out hands-on. Many questions arise especially whether students are satisfied with virtual skill learning and whether virtual skill learning is sufficient for students to undergo clinical training. University closures also indicate that students may not be properly placed for clinical activities ^[3]. Students may not receive adequate instruction in handling Covid-19 imaging methods and proper infection prevention and control techniques. Students cannot be placed for clinical practice according to closure guidelines due to housing difficulties, family isolation and travel for clinical placement ^[3]. Therefore, this study aims to assess the impact of the Covid-19 pandemic on medical imaging students at the Universiti Sultan Zainal Abidin (UniSZA) in relation to their theoretical learning and clinical training.

Materials and Methods Study design

This is a cross-sectional survey among students under the School of Medical Imaging, Faculty of Health Sciences, Universiti Sultan Zainal Abidin (UniSZA). The survey was conducted from September 2022 to April 2023.

Ethical statement

Ethical approval was obtained from the UniSZA Human Research Ethics Committee (UHREC) [UniSZA/UHREC/2022/424].

Study participants

The participants involved in this study were students of Diploma Radiography and Bachelor in Medical Imaging in UniSZA. The participants selected in this study were students who underwent theoretical learning and clinical training through the period starting from March 2020 until March 2022. The sample size was determined using an online software, Raosoft. With a 5% margin of error, 95% confidence level and 199 population size, a total of 112 respondents is the recommended sample size. However, only 55 participants were involved in this survey due to the availability and readiness of the students. The participant was selected using non-probability sampling.

Measurement tools

The survey was collected using questionnaires distributed online through Google Forms. The set of questionnaires was adapted from a previous study ^[3], therefore no validation and reliability test were done on the questionnaire. The questionnaire consists of 4 sections; demographic, perspective on theoretical learning during the pandemic, perspective on clinical training during the pandemic and challenges experienced in online/virtual learning. The demographic sections cover data including gender, age, diploma/bachelor degree program and frequency of clinical training during the study period. Another three sections consist of 15 questions using a Likert scale with five alternative answers, namely: 1 (strongly agree), 2 (agree), 3 (neutral), 4 (disagree) and 5 (strongly disagree).

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Data analysis

Descriptive statistics are used in the statistical analysis to assess the characteristics of the respondents and their responses using frequencies and percentages. The data was analyzed using Microsoft Excel. The summarized data is presented in the table and bar chart.

Result and Discussion

A total of 55 respondents answered this questionnaire. Table 1 summarises the demographic data of the respondents. 51 out of 55 is female participle while only 5 participant is male. 78.18% of participant is from Bachelor’s degree in Medical Imaging while 21.82% is from Diploma Radiography. In terms of the frequency of clinical training throughout the study period, the majority of the participants attended clinical training twice (41.82%), 34.55% of participants only attended clinical training once and another 23.64%

attended clinical training three times during the pandemic.

Table 1: Demographic characteristics of respondents (N=55)

Demographic characteristics Frequency (n) Percentage (%)

Gender

Female 51 92.73

Male 4 7.27

Age

18-21 years old 42 76.36

22-25 years old 9 16.36

26-30 years old 4 7.27

Level of education

Diploma of radiography 12 21.82

Bachelor of medical imaging 43 78.18

Frequency of clinical practice during the study period

One time 19 34.55

Two times 23 41.82

Three times 13 23.64

The second section is the perspective on theoretical learning during the pandemic. The frequency and percentage of the response are summarized in Table 2. From the result, 54.55% of students strongly agreed that learning basic radiography subjects through online learning is hard to focus on. Previous study shows some student have difficulty focusing during online learning due to unfamiliar learning through gadgets^[4]. Another reason is the lack of group discussion or peer group studies among friends. During online delivery, students have more control over their learning; anytime and anywhere, but there is no peer-to-peer or instructor-to-peer interaction ^[5]. Lack of human interaction, facial expression and body language pose obstacles to online learning ^[6]. The second highest score is 52.73 % of students strongly agreed that learning ‘hands-on’ skill training is hard and ineffective. Learning skills should be done in physical situations, not in virtual which might lead to less confidence. Based on the previous study among vocational students involved in hands-on and practical skill training, the majority of respondents feel that online learning is considered less effective and in line with their expectations ^[7]. Even though learning hands-on virtually is ineffective, 16.63% of students strongly agree that simulation video helps them to

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improve their radiographic skills. This might be due to the video recorded by the lecturers and clinical instructor, which helped them better understand the skill. For the image critique through online learning, 40% of participants have no argument on this. However, 29.9% agree that learning image critique online is easy and efficient. The result from this section shows that medical imaging students in UniSZA are highly impacted on their theoretical learning as they were having difficulty learning online during the COVID-19 pandemic. To increase social distancing and reduce the spread of the COVID-19 infection, some medical schools and research institutions have stopped in-person instruction and scientific research operations.

Academic program activities and research activities in radiology have also been disrupted, with immediate and long-term effects ^[8]. Changing learning patterns and students spending a lot of time getting used to their devices are the challenges faced when switching to online learning^[4].

Table 2: Perspectives on theoretical learning during Covid-19

The third section is the perspectives on clinical training during the pandemic. The result is summarized in Table 3. Out of the five questions presented in this section, none of the questions were disagreed with by the respondents. This shows that the majority of the students are affected during clinical training during the pandemic period. During clinical training within the pandemic period, 56.26% of students are always worried about being infected with the COVID-19 virus because this will interfere with their clinical practice period, 41.82% of students find it difficult to learn patient positioning and have limited access to all imaging modalities, and 25.45% of students strongly agree that is hard to collect cases during the clinical training period. While the use of PPE is not an obstacle for students in positioning patients where 41.82% of students have no argument on that matter. A study done among radiology students at King Saud bin Abdul Aziz University for Health Sciences (KSAU-HS) shows that the majority of the students worried about their health during clinical rotation ^[9].

Questions Strongly

agree Agree Neutral Disagree Strongly disagree Learning theoretical subjects through

online learning during a pandemic is hard to understand.

34.55 %

(n = 19) 40 %

(n = 22) 25.45 %

(n = 14) 0 %

(n = 0) 0 % (n = 0) Learning basic radiography subjects

(e.g. physics, instrumentation) through online learning during a pandemic is hard to focus on.

54.55 %

(n = 30) 38.18 %

(n = 21) 7.27 %

(n = 4) 0 %

(n = 0) 0 % (n = 0)

Learning radiographic and hands-on skills training (e.g. radiographic

techniques) virtually during a pandemic is hard and ineffective.

52.73 %

(n = 29) 40 %

(n = 22) 7.27 %

(n = 4) 0 %

(n = 0) 0 % (n = 0)

Simulation videos related to

radiographic techniques can improve radiographic skills.

16.63 %

(n = 9) 0 %

(n = 0) 45.45%

(n = 25) 32.73 %

(n = 18) 5.45 % (n = 3) Learning image critique through online

learning and digital images is easy and efficient.

9.09 %

(n = 5) 29. 09%

(n = 16) 40 %

(n = 22) 18.18 %

(n = 10) 3.63 % (n = 2)

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Table 3: Perspectives on clinical training during Covid-19

Questions Strongly

agree Agree Neutral Disagree Strongly disagree Within the pandemic period, it is difficult

to learn the radiographic technique of positioning patients during clinical.

41.82 %

(n = 23) 47.27 %

(n = 26) 10.91 %

(n = 6) 0 %

(n = 0) 0 % (n = 0)

During the clinical training within the pandemic period, access to all imaging modalities within the radiology department was limited.

41.82 %

(n = 23) 47.27 %

(n = 26) 10.91 %

(n = 6) 0 %

(n = 0) 0 % (n = 0)

During clinical training within the pandemic period, I was unable to collect radiographic cases due to the limited clinical duration.

25.45%

(n = 14) 61.82 %

(n = 34) 12.73 %

(n = 7) 0 %

(n = 0) 0 % (n = 0)

During clinical training within the pandemic period, I was always worried about being infected with the Covid-19 virus and this interrupted my clinical training sessions.

56.36 %

(n = 31) 30.91 %

(n = 17) 12.73 %

(n = 7) 0 %

(n = 0) 0 % (n = 0)

During clinical training within the pandemic period, patient positioning became very difficult due to the use of PPE.

30.91 %

(n = 17) 27.27 %

(n = 25) 41.82 %

(n = 23) 0 %

(n = 0) 0 % (n = 0)

One of the difficulties students face during clinical training is unable to learn how to position patients. This is due to virtually learning the theory of patient positioning where the student did not have hands-on radiography skill session before going to clinical training. Therefore, students are not confident and not competent to position patients during clinical training. Previous studies discussed that lack of hands-on sessions had a major influence on clinical training because students cannot apply theoretical learning to practice ^[10]. Students also face difficulties in accessing all imaging modalities due to time constraints of clinical training. During the pandemic period, most hospitals only accept students for a short period; 2-4 weeks only, whereas the clinical training period for UniSZA medical imaging students is at least 7 weeks for each placement. Due to the shortened clinical placement period, students do not have enough time to practice which causes them to have less experience working in the field ^[11].

During the COVID-19 pandemic, most health institutions had to reduce the number of employees at a certain time and apply a rotation system. The reduction of workers in the radiography examination room is to maintain physical distance to control the spread of COVID-19. This situation causes the practical students less supervised by hospital staff and local preceptors. This is also the reason why students are unable to collect radiographic cases and have difficulties learning patient positions during clinical training.

In addition, precautions and safety measures were implemented to reduce congestion in radiology departments’ activities and this led to extra work among staff at the radiology department therefore, hospital staff may also have less time to teach and supervise practical students ^[11].

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Figure 1: The challenges experienced during online learning

The last part is the challenges experienced in online/virtual learning. The result is presented in the bar chart in Fig. 1. From the result, 41.82% of students agreed that internet connectivity is the main challenge during online learning, followed by internet affordability (21.82%). A study in South Africa also shows that problems related to internet connectivity and data are the main reason that students are unable to view online courses and online teaching does not consider the connectivity issues in rural areas^[4]. A study done on medical students also states that no internet Wi-Fi access and no broadband coverage are the barriers to online learning ^[12]. Many countries have substantial issues with reliable Internet connection and access to digital devices ^[13]. The use of online delivery has its drawbacks since those who are less technologically proficient may find it difficult, and students without easy access to the internet or laptops may find it difficult to participate regularly.

Learning radiography involves theoretical basic courses, handling equipment, hands-on skill projection patient and clinical practice. However, as a result of the COVID-19 pandemic, all chances for formal and informal learning in person have been eliminated, and health professional courses must now only be delivered online. This study shows that most of the medical imaging students in UniSZA experienced difficulties in their learning process during the pandemic period. The COVID-19 pandemic has affected their theoretical learning as well as their clinical practice. The lack of hands-on skills during theoretical learning causes them to lack confidence in positioning patients and this leads to difficulties during clinical training.

Completing clinical placement is one of the biggest challenges faced by radiography students ^[14]. Clinical placement enables students to understand the practical side, giving an insight into real working environments in the future. It was highlighted that due to the few and particular kinds of cases encountered during the pandemic, students expressed difficulty completing the learning objectives for evaluations ^[10]. Conclusion

In conclusion, the Covid-19 pandemic has highly impacted the learning activities of medical imaging students at UniSZA. Radiography education requires special consideration to ensure appropriate measures to support the ongoing need. Therefore, radiography and medical imaging students were struggling with all the challenges, blending in the new method of learning activities during the pandemic Covid-19 to become competent radiographers.

Funding

The author(s) received no specific funding for this work.

Internet

connectivity Inadaquate time

for discussion Internet

affordability Lack of computer

devices

Lack of personal touch

% Of respondent

41.82%

21.82%

7.27%

14.55%

10.91%

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Conflict of Interest Disclosure None to declare

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