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 Table of Contents  
Year : 2023  |  Volume : 11  |  Issue : 1  |  Page : 26-29

Transformation of ophthalmology education during the Coronavirus Disease 2019 pandemic by E-learning in India

Department of Ophthalmology, Base Hospital, Delhi Cantt, Army College of Medical Sciences, New Delhi, India

Date of Submission12-Feb-2022
Date of Decision04-Dec-2022
Date of Acceptance25-Dec-2022
Date of Web Publication8-Feb-2023

Correspondence Address:
Meenakshi Pathania
Department of Ophthalmology, Base Hospital, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcor.jcor_27_22

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Purpose: The purpose of this study was to assess the impact of the coronavirus disease 2019 pandemic imposed social distancing measures on the learning of ophthalmology in the institutions involved in the training of the ophthalmologists and the use of alternate E-learning methods to maintain the standard of education. Materials and Methods: This study was conducted among the postgraduate residents and faculty involved in ophthalmology-related education from October 15, 2020, to September 15, 2021. The study was based on a questionnaire performed based on a Google Form that was sent to the participants. Results: A total of 345 participants completed the survey. Most of the participants were using conventional learning methods such as lectures, ward rounds, clinical meets, and journal clubs. E-learning techniques showed a statistically significant increase during the pandemic (P < 0.001). Theoretical studies continued but the surgical training of the residents and fellows was significantly reduced. Conclusion: During the pandemic due to the imposed challenges in ophthalmology learning, even though surgical learning suffered, there was a significant increase in the utilization of E-learning alternatives, opening a new arena of learning opportunities.

Keywords: Coronavirus disease 2019, ophthalmology learning, transformation

How to cite this article:
Pathania M, Chaudhary R, Attri J. Transformation of ophthalmology education during the Coronavirus Disease 2019 pandemic by E-learning in India. J Clin Ophthalmol Res 2023;11:26-9

How to cite this URL:
Pathania M, Chaudhary R, Attri J. Transformation of ophthalmology education during the Coronavirus Disease 2019 pandemic by E-learning in India. J Clin Ophthalmol Res [serial online] 2023 [cited 2023 Mar 23];11:26-9. Available from: https://www.jcor.in/text.asp?2023/11/1/26/369350

The novel coronavirus disease 2019 (COVID-19) cases were initially reported in Wuhan, China, by the end of the year 2019 as atypical pneumonia cases outbreak that spread fast as a cause of public health threat globally.[1] COVID-19 is a new infection that tends to involve both the upper as well as lower respiratory tracts through aerosols and fomites.[2] The global spread of COVID-19 led the World Health Organization to declare it a pandemic on March 11, 2020.[3] A potentially fatal form of this disease is termed severe acute respiratory syndrome (SARS) which is caused by an extremely contagious RNA virus called SARS coronavirus 2 with an amazing capability to mutate as compared to DNA viruses giving it rapid mutation rates.[4]

Medical personnel is at high risk, especially ophthalmologists which may be attributed to main reasons such as the presence of virus in the tear fluid, the need for proximity to patients for examination, and deceiving symptoms of the disease. The coronavirus was found in the conjunctival secretions of COVID-19-positive patients who have conjunctivitis.[5] While examining the infected patient, there is a fairly high chance of contaminating the fingers.[6] The symptoms of COVID-19 have range of being asymptomatic to having fever, cough, breathlessness, fatigue, muscle aches, and loss of smell and taste.[7]

The measures of physical distancing have been followed. A lot of additional resources allocated for the management of COVID-19 patients and to reduce its spread have been undertaken which include reducing clinic visits and minimizing elective surgeries. In ophthalmology, many practices have been adopted to protect patients and health-care providers.[8]

During this global pandemic, the clinical practice in eye care has significantly been affected. In the given circumstances, how to cope with training in ophthalmology is a very significant question. COVID-19 has affected the educational experience of trainees and ophthalmologists worldwide. It has presented to us never before seen challenges.

In some cases, teleophthalmology has been employed for screening and basic visits to reduce the spread of infection. This presents a unique learning experience for the trainees.

However, a decrease in the volume of the cases seen and surgeries performed presents a significant challenge for the trainees. The departmental ward rounds, seminars, and conferences have been postponed, reduced, or are being held on a virtual platform.[9]

There is an increase in the use of E-learning platforms in the form of webinars, podcasts, and online symposia.[10]

Even though these cannot replace interpersonal interaction and traditional learning but can compensate for it in some way and these conditions add a unique learning experience for the trainees.

The learning is impacted by the limited number of patients for ocular examination and surgeries but this is a chance for the trainees to learn telemedicine which will become more important in the future.

  Materials and Methods Top

This survey was developed based on the Google Form questionnaire which consisted of 24 questions to evaluate the impact of E-learning in ophthalmology before and after the COVID-19 pandemic. The questionnaire was approved by six ophthalmologists for appropriateness of the questions and responses and the survey was limited to important questions which would reveal the essence of the study without causing respondent fatigue and improve the style following the guidelines in the conduct and reporting of the survey research.[11],[12] The ethical clearance was taken from the allocated ethical committee. The survey included trainees in ophthalmology and ophthalmologists involved in training them. The survey did not require the participants to mention their identities to avoid bias. The survey was conducted exclusively in the English language. Responders could only answer the survey once. Participation in the survey was completely anonymous, voluntary, and without any reimbursements. Logic regression models were used to assess the physical characteristics associated with the teaching practice perspectives. Association between categorical variables was assessed using Fisher's exact test or Chi-squared test. We considered a P < 0.05 as statistically significant. All statistical analyses were performed with GraphPad Prism 6 (GraphPad Inc, La Jolla). For the categorical data, statistics of numbers with percentages were mentioned.

  Results Top

Out of 520 ophthalmologists and trainees contacted, 345 completed the questionnaire, a response rate of 66.34%.

Participant demographics

Out of 345 participants, 156 were males (45.21%) and 188 were females (54.49%) as shown in [Figure 1]. One person preferred not to disclose their gender. The sample represented various educational grades, [Figure 2] including trainees (n = 156, 45.21%), fellows (n = 20, 5.7%), clinicians (152, 44.05%), and heads of teaching programs (n = 17, 4.92%), with a variable experience in ophthalmology. Many of them had expertise in vitreoretinal, cornea, and oculoplastic while other subspecialties were also represented. It covered various components of ophthalmology teaching including teachers and students to make proper analysis.
Figure 1: Gender distribution among participants

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Figure 2: Distribution of designation of participants

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The respondents were asked to specify the funding of their training centers: 193 (55.9%) were in government-owned hospitals, 113 (32.7%) mentioned that their institutes were privately owned, and 39 (11.3%) were in charitable/trust-owned hospitals [Figure 3].
Figure 3: Distribution of funding of the participants workplace

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Training before and during the pandemic

In the training of ophthalmology, various alternatives were used by various institutions. Before the pandemic, most participants used lectures (n = 320, 92.7%), grand rounds and case studies (n = 254, 73.62%), journal clubs (n = 205, 59.42%), and videos (n = 142, 41.16%) for teaching, whereas web-based lessons (n = 111, 32.17%), virtual meetings from conferences (n = 62, 17.9%), live streaming video conference (n = 72, 20.86%), and E-class platforms (n = 36, 10.43%) were less common [Figure 4].
Figure 4: Modes of training before and during the coronavirus disease pandemic

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During the pandemic, there was a significant reduction in the traditional teaching ways, for example, lectures, grand rounds, journal clubs, and videos (P < 0.001) as shown in [Figure 4]. During the pandemic, there was a significant increase in the utilization of E-learning alternatives (P < 0.001).

Before the pandemic, 49% (n = 169) of participants had not utilized E-learning platforms. As depicted in [Figure 5], during the COVID-19 pandemic, this reduced significantly to 23.19% (n = 80, P < 0.001). Before the pandemic, the commonly used E-learning platforms were Zoom, Skype, and Microsoft Teams. During the COVID-19 pandemic, there was a statistically significant increase in the use of Zoom, Skype, Cisco Web, Google Meet, Adobe Connects, and Microsoft Teams (P < 0.001).
Figure 5: Comparison of E-learning platforms used before and during pandemic

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There was a statistically significant reduction in the time spent in surgical training during the pandemic as shown in [Figure 6] (P < 0.001).
Figure 6: Comparison of hours of surgical training before and during the pandemic

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  Discussion Top

This online survey which was a cross-sectional study found that there was a statistically significant increase in the utilization of E-learning platforms in ophthalmology during the pandemic. In fact, before the COVID-19 pandemic, 49% of the participants in the study had not used virtual training platforms. During the COVID-19 pandemic, there was a statistically significant increase in distance learning, with Zoom being the most common E-learning platform for distance education. The availability of E-learning platforms was associated with the use of distance education. The teaching times for the theoretical training were maintained but the surgical training was reduced during the COVID-19 pandemic due to a reduction in elective surgeries. This caused a negative perspective on the quality of training during the COVID-19 pandemic. The E-learning platforms for training in ophthalmology are likely to be improved markedly.

The E-learning platform to provide training with the use of the Internet is increasingly becoming popular for education including medical professionals.[13] There are two types of E-learning, the first is synchronous, in which all participants need to be online at the same time, and the other is asynchronous, in which different participants can access it at any time.[14]

With the increase in peculiar requirements of this pandemic, disruption in medical education is likely and we have to try to find the best ways possible to keep up the training and lay the foundation of teaching techniques for the future.[15],[16]

The positive aspect of the pandemic is greater utilization and development of skills in the use of E-learning platforms. There has been a paradigm shift from face-to-face interactions to online video conferences. Medical professionals can attend at a more convenient time at reduced costs, especially during out-of-city conferences. The disadvantage is a restriction on in-person collaboration and a significant reduction in time spent in surgical training during pandemics and a reduction in direct clinical care poses an educational challenge. Online education is fine for training the residents theoretically but sound clinical practice needs patient contact for a good diagnostic clinical thought process. Reduced elective surgeries and social distancing have presented as a handicap in trainee teaching. The surgical simulation including wet laboratories and cataract and vitreoretinal surgical simulators are very effective but are not capable of substituting real-life surgical training scenarios. Most of the participants believed that the experience of E-learning will be used in the future training in ophthalmology training. These can be used as an adjunct to conventional education methods and not as a replacement. Potential limitations of this study are the possibility of selection bias of participants in a random way may exist. However, the survey represented physicians from all experience levels which makes the results largely generalizable. Furthermore, a memory bias of the participants is possible as they were expected to report questions on their practice patterns.

  Conclusion Top

COVID-19 has presented an unprecedented challenge for efficient training in ophthalmology. In these times of uncertainty, unique opportunities lie for the development of knowledge. Many modalities are promising such as virtual learning platforms, surgical simulation, and independent home study. E-learning is likely to become a supplement to conventional teaching and the possibility to learn from anywhere globally. Accepting the challenges and finding opportunities, ways for high-quality education in ophthalmology have to be explored in the future.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Cucinotta D, Vanelli M. WHO declared COVID-19 a pandemic. Act Biomed 2020;91:157-60.  Back to cited text no. 3
Sanjuán R, Domingo-Calap P. Mechanisms of viral mutation. Cell Mol Life Sci 2016;73:4433-48.  Back to cited text no. 4
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Seah I, Su X, Lingam G. Revisiting the dangers of the coronavirus in the ophthalmology practice. Eye (Lond) 2020;34:1155-7.  Back to cited text no. 6
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Li JO, Lam DS, Chen Y, Ting DS. Novel coronavirus disease 2019 (COVID-19): The importance of recognising possible early ocular manifestation and using protective eyewear. Br J Ophthalmol 2020;104:297-8.  Back to cited text no. 8
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Tran EM, Tran MM, Clark MA, Scott IU, Margo CE, Cosenza C, et al. Assessing the quality of published surveys in ophthalmology. Ophthalmic Epidemiol 2020;27:339-43.  Back to cited text no. 11
Kelley K, Clark B, Brown V, Sitzia J. Good practice in the conduct and reporting of survey research. Int J Qual Health Care 2003;15:261-6.  Back to cited text no. 12
Zollo SA, Kienzle MG, Henshaw Z, Crist LG, Wakefield DS. Tele-education in a telemedicine environment: Implications for rural health care and academic medical centers. J Med Syst 1999;23:107-22.  Back to cited text no. 13
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Chick RC, Clifton GT, Peace KM, Propper BW, Hale DF, Alseidi AA, et al. Using technology to maintain the education of residents during the COVID-19 pandemic. J Surg Educ 2020;77:729-32.  Back to cited text no. 15
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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