Exploring Ghanaian medical students’ learning experiences during the COVID-19 lockdown: a case study of the University for Development Studies Medical School

Introduction

Coronavirus disease (COVID-19) is an infectious disease caused by a new coronavirus that has not been previously identified in humans. It was first identified in Wuhan, China on the 23^rd of December 2019. According to UNICEF, since its discovery, its geographic distribution has continued to evolve. World Health Organization (WHO) reported that globally the outbreak affected 216 countries, with over 13 million cases and 500,000 deaths. Ghana recorded its first two cases from Norway and Turkey returnees on the 12^th of March 2020, since then the numbers have continued to rise. On the 4^th of May 2020, Ghana Health Service (GHS) reported 2,719 cases and 18 deaths occurring in 12 out of the 16 regions in the country within two months, amid three weeks of lockdown, intensive screening, and indefinite closure of schools for containment of the virus. Due to the infectious nature of the outbreak many countries attempted to observe the principle of social distancing through resorting to school closure which included health education institutions, to curtail the rising consequences of the outbreak. As shown in UNICEF Ghana report, this affected over 1.2 million learners, representing over 60% of the world’s student population.

COVID-19 continues to affect educational institutions in so many ways even though according to another UNICEF Ghana report alternative educational measures have been adopted through online learning, using various platforms such as zoom, WhatsApp, and Google Classroom in place of the traditional method of instruction (face-to-face delivery) to continue educating students in their homes while observing physical distancing. The approach comes with its challenges, especially in developing countries (low-and middle-income countries) as its ability to raise or maintain the expected quality of health professionals is a concern. For example, in the Philippines, the Commission on Higher Education (CHED) suspended the online form of instruction following resistance from students, including teachers who clamoured against the online mode of learning due to different factors including schools’ lack of preparation for the implementation of these due to inadequate access to internet and online educational resources (Toquero, 2020).

For a variety of reasons, many schools in the world including Ghana had also suspended all academic activities including clinical clerkships. One reason was to flatten the COVID-19 curve, another reason was to lessen the risk of exposure of student health professionals, although some students may be willing to put themselves at risk to provide support in combat (Ferrel & Ryan, 2020). According to literature, clinical skills training is a crucial moment in student developmental stage where clinical examination and reasoning skills, including therapeutic communication skills with patients, and multi-disciplinary teams are developed to enhance effective diagnosing and client adherence to treatment (Adebisi et al., 2020; Cecilio-Fernandes et al., 2020). All of these activities greatly diminished with an online learning environment, which gave no room for real-life clinical practice (Adebisi et al., 2020; Cecilio-Fernandes et al., 2020). Despite the growing trend of perceived challenges of online learning on the skills development of student health professionals, health educators across the globe continued to stress the need to protect students, arguing that the risks of exposure of students may be greater than the educational benefits of remaining in clinical settings or schools to learn about the new clinical entities, even though their services may be needed in times of healthcare worker shortage (Anderson et al., 2020). As many student health professionals were missing out on the valuable experiences of presentations, clinical rotations, and collaborative experiences of standards which helped previous generations to become doctors, it poses the question about how these students will evolve and integrate themselves into the medical community given the situation of a prolonged COVID-19 pandemic, or another future incidence of infectious disease (Ferrel & Ryan, 2020).

Due to the above concerns, there are growing anxieties about the ability of online studies to produce the expected outcome of qualified health professionals, especially in developing and middle-income countries. Though several studies regarding COVID-19 have been conducted so far in relation to the medical field and other fields related to health sciences, very few studies have been undertaken to ascertain the impact of COVID-19 in the field of health professions education in Ghana (Sintema, 2020). There is thus the need to explore the learning experiences of student health professionals, especially during the adoption of online learning during the COVID-19 lockdown. This study leveraged on the impact of online learning on the professional development of student health professionals to draw recommendations for the overall improvement of the online learning system, with the aim of meeting the standards of health professions education in times of future crisis.

Methods

Results

A total of 202 students responded to the open-ended questionnaire (Amalba et al., 2023). Table 1 shows the general characteristics of the students. Participants had a mean age of 23.20 years, and the majority were male. There was no consideration of sex segregation in the design of the study and data analysis because this did not apply to this study, as both males and females had equal access to the online learning system in Ghana.

Discussion

In this study we explored the impact of the COVID-19 pandemic/lockdown and its associated online learning on the professional development of student health professionals.

A significant number of the participants (n=133, 67%) strongly described the online learning during the COVID-19 pandemic/lockdown as completely inadequate, ineffective and an expensive mode of learning. Students considered this mode of learning as a sudden, expensive, and challenging change, similar to previous findings reported from the Philippines, where both students and teachers strongly opposed the use of online learning during COVID-19 due to it being an abrupt and expensive initiative that they were not prepared for (Toquero, 2020). Students incurred extra cost to acquire the needed technological devices and internet services to be able to engage in online learning, which confirms the expensive out-of-pocket expenditure on internet data bundles that medical and pharmacy students in Nigeria also experienced (Adebisi et al., 2020). This partly contributed to the resistance met by online learning during the COVID-19 pandemic.

Also, due to the practical nature of the training of health professionals, most participants were very sceptical about the ability of online learning to adequately prepare them for future health care practice. For instance, they cited the loss of clinical skills training, laboratory training and the usual clinical rotations in hospitals due to social distancing as major setbacks to their skills development during the COVID-19 pandemic as also shown in a study by Cecilio-Fernandes et al., (2020). Our study further established the findings of previous studies that indicated that online learning poses major challenges to the training of future health professionals (Adebisi et al., 2020; Ferrel & Ryan, 2020).

Time constraints and the overload of coursework were major effects of COVID-19 lockdown on the learning and professional development of participants in this study. Due to the closure of schools as part of the measure to reduce the spread of the COVID-19 virus, students stayed home for months without any academic work. This delayed the completion of the academic year and placed pressure on students and faculty to do more work in a limited time to catch up on the time lost. This was similar to the experiences of medical and pharmacy students in Nigeria whose studies were also halted, and major professional examinations suspended, due to their government’s measures to curb the spread of the virus (Adebisi et al., 2020). This could result in low performance in the professional examination post-pandemic and the general competency of these future health professionals and must be given the needed attention.

One challenge also revealed in this study is the lack of supervision and guided learning. The social restrictions during the pandemic took away the face-to-face interactions which included lectures, tutorials, skills training, laboratory training and hospital visitation sessions that students engaged in under the regular PBL module. The shift to online learning took away the guided learning and supervision students usually received from their lecturers in the regular PBL module. It also made it difficult for students to ask questions and get guidance on certain critical topics they found difficult to understand. This made some students feel lazy and less committed to their studies during the lockdown, as found in similar studies where medical students had difficulties in concentrating and learning effectively (Aftab et al., 2021; Cecilio-Fernandes et al., 2020). This poses a threat to the competencies and readiness of students in their future profession.

Quite similarly, the closure of schools due to COVID-19 and the use of online learning during this period, resulted in less interaction between students and their lecturers as well as their peers. Participants indicated that they missed the regular skills training, laboratory training, hospital visitation and tutorial sessions that allowed them to get practical training and direct interaction with lecturers as well as their peers. As found in other studies, our study revealed that the use of the online lectures and demonstrative videos could not address the needed practical skills students gained from observing and engaging directly with their lecturers (Cecilio-Fernandes et al., 2020; Ferrel & Ryan, 2020). The collaborative learning at tutorial sessions was also missing and that took away the peer supported learning and social bonding of meeting in groups for tutorials. Thus, the social relations and mental well-being of students which is relevant for future practice was negatively affected (Adebisi et al., 2020).

The COVID-19 restrictions which led to the closure of schools also limited students’ accessibility to the physical library and other learning resources on campus. Health professionals require certain competencies and skills to be able to work diligently in their profession, therefore their training in school needs to equip them with the best of these competencies and skills. Access to library and other relevant resources complements the lectures and practical training to equip students with the needed knowledge and competencies for their professional practice. This confirms the findings in Nigeria which identified that it was difficult for students to find e-sources for some practical pharmacy and medical courses during the pandemic (Adebisi et al., 2020). The pandemic therefore challenged the comprehensive professional development of health professional students.

Another worrying situation students faced during the COVID-19 pandemic was the unfavourable learning environment at home. As schools were closed, students had to stay home for some months and resort to online lectures and self-study to cope with their academic work. According to our study, the home did not provide the best environment for effective learning for most students. There were several distractions like chores and other family engagements that did not give them the best study time. Most students also lived in communities that did not have good internet connectivity. Such students were unable to participate effectively in the online lectures the university resorted to. This resonates with in the findings of a similar study in Brazil (Cecilio-Fernandes et al., 2020). In addition to these challenges, frequent power outages were said to have affected the learning experiences of medical and pharmacy students in Nigeria during the pandemic (Adebisi et al., 2020). The social restrictions of COVID-19 therefore hindered the conducive learning environment needed for effective learning which further translates into effective professional development for practice.

Amidst reports of the negative impact of COVID-19 on learning among students of health profession at the UDS, a few positive experiences were also identified. Generally, in this study, one positive impact of the online learning system adopted by the institution during the pandemic was the reduction in the person-to-person interactions, which minimized the spread of the virus among the university community as seen in other studies too (Anderson et al., 2020). This resonates with the findings of other studies that identified the large shift to online instruction as a means of limiting face to face interaction between teachers and the students, to prevent the spread of the virus and preserve lives for the needed future human resources (Toquero, 2020).

Also, about 12% of the study participants (n=23, 12%) believed that online learning during the COVID-19 pandemic was good. It helped both faculty and students to adapt innovative teaching and learning methods. Just as it was identified by Toquero (2020), this study also revealed that the online learning system adapted during the COVID-19 pandemic caused students to learn and make use of new learning modes to keep up with their learning. Thus, in a positive way, the situation challenged students and faculty to get out of their comfort zone of classroom interaction, to adapt other new technological methods of teaching and learning. Some participants stated that online learning will be adequate to provide them with the required competencies as health professionals if improved electronic learning systems are put in place by the university.

Similarly, the adaption of e-learning during the pandemic also made learning a more student-centred and self-motivated process for students. Our study found that amid the pandemic, students had more time on their hands to engage in self-directed learning. There were no physical classroom interactions which meant that students did not have to face the challenges of travelling to campus as well as missing and rescheduling lectures due to unavailability of lecture rooms or lecturers. This gave students enough time to do more self-studies. Students had more time to study on their own, at their own pace and in the comfort of their homes. This improved personal studies for some students as they were in better control of their studies and were able to explore new learning opportunities to learn new things as also shown in the findings of a similar study in the Philippines (Toquero, 2020).

Conclusion

Practical clinical training is an essential part of health professional training. In the wake of technological development and innovative learning, it will be a good thing for higher educational institutions (including health professional training institutions) to identify and utilize innovative ways of teaching practical and clinical skills. This will help maintain the standards and quality of health professional training, even in the wake of other pandemics in future. Educational institutions need to improve technological and internet facilities in their institutions to improve online teaching and learning in this technological era. It is also important for faculty and students to have an effective system of communication in order to give and receive feedback and the needed support with online learning.