Perception Of E-Learning In Medical Students Of Fatima Jinnah Medical University

Introduction: In the modern era, advancing information technology is leaving an impact on the educational system as well wherein classroom learning is being replaced by e-learning. This type of learning is a part of formal educational system in many institutions around the globe. HEC is emphasizing the implementation of e-learning in formal education, thus perception of students about e learning need to be known. Aims & Objectives: To determine the perception of medical students of FJMU regarding e-learning. All institutions throughout world had to shift to online learning during COVID-19 pandemic. This new online system is challenging for many students. The current study was planned to know the perception of medical students of FJMU about e-learning. Place and Duration of Study: This was a descriptive cross-sectional study that took place in FJMU, Lahore and duration of study was 2 weeks in August 2021. Material & Methods: The study was conducted on 377 medical students of 1 st and 2 nd year MBBS. Nonprobability purposive sampling technique was employed. A predesigned and pretested questionnaire was administered to the students in August 2021. Data was analyzed by SPSS 23 and frequency % was calculated for quantitative variables as perceived usefulness, perceived ease of use and e learning stressors were calculated. Results: Mean age of students were 19.4 years, with range of 18-22 years and all were females. Majority (85%) used mobile phones for e-learning. 72.6% of the students preferred face to face learning over e-learning. Major stressors included inadequate IT skills, lack of motivation and poor internet connections. Conclusion: Medical students of FJMU didn’t prefer e - learning over


INTRODUCTION
Learning is the process of obtaining knowledge and skills through study or other means for a specific purpose.As time is passing, the trends and modes of learning are changing day by day.The majority students are using mobile phones, laptops, tabs and tools like that for acquiring knowledge.The traditional ways of learning are gradually being replaced by new systems involving use of information technology (IT) 1 .Thus, the modes of learning are classroom model, online or e-learning and blended learning.Classroom model demands the physical presence of teacher and students in a room and learning is by their direct communication to each other.E-learning is totally virtual by means of use of computer and internet technologies in which there is no physical communication amongst teachers and students, while blended model is the mixture of both forms 2 .E-learning system is a part of formal education in many universities across the world and many learners prefer this system due to being easy, flexible, and controllable in terms of time and place 3,4,5 .A study conducted in Syiah Kuala University, Indonesia showed a positive response of students towards online learning and their students enjoy this learning 6 .But other learners prefer face to face learning due to lack of student teacher interaction and complexity of the process as students of Air-langga University, also in Indonesia rejected the e-learning system due to being a complex process 7 .Similarly, another study on university students in Oman highlighted barriers to online learning and preferred face to face system 8 , while a study conducted in University of Sharjah in United Arab Emirates showed a positive attitude of students towards online learning 9 .In comparison to the world, in Pakistan e-learning is not a part of our routine educational system but in year 2020, this system was used in many institutions.Due to the Covid-19 pandemic, almost all educational institutions were closed around the globe.To prevent the academic loss, all institutions including medical schools have tried to facilitate the students by providing online learning using google classrooms, webinars, online video meetings etc.This has raised multiple challenges for the students 10,11 .Thus most of our faculty members and students are in process of getting used to new online teaching system, as reflected by the study conducted in Liaquat Medical & Dental College in Karachi showed negative impact of online learning in medical students during the current situation 22 .Higher education system of Pakistan is emphasizing the implementation of e-learning system in formal education throughout the country 13 .That's why it is necessary to know the students point of view regarding the acceptability of e-learning system.So, a study is planned to determine the perception of medical students of FJMU regarding e-learning in the current situation.

Ethical approval of study was taken from
Institutional/ Ethical Review Board of FJMU with number 12/CIERB dated 09-08-2021.A Descriptive cross sectional study was conducted at FJMU, Lahore for a period of 2 weeks in August 2021.Using the non probability purposive sampling 377 1 st and 2 nd year MBBS were inducted in the study as calculated by Rao soft 14 ) A predesigned and pretested questionnaire obtained from a study conducted on university students in Ghana with slight modification was used 15 .The Questionnaire had 21 questions divided into 6 subdivisions.1 st one was the general information.The remaining 4 sections were based on the technology Acceptance Model (TAM) and covered the following: Perceived usefulness (PU) of e-learning Perceived ease of use (PE) Attitude towards e-learning (AT) Intention to use (IU) e-learning in future.And final subdivision included e-learning stressors.All Items were assessed on 5 point Likert scale, from strongly disagree 1, disagree 2, no response 3, agree 4 and strongly agree 5.At the end, participants were thanked for their cooperation.Data was collected by administering the questionnaire to the students during tutorial classes.Data Analysis: Data was entered and analyzed in SPSS-23.Descriptive statistics was applied for getting the frequency percentage of the data.

RESULTS
The current study has been conducted on 377, 1 st and 2 nd year medical students of FJMU.Mean age of students was 19.4years with range of 18-22 years.All students were females and majority used mobile phones (85%) for the online learning.Most of the students liked zoom app for learning (74.2%).The general characteristics of study participants are given in Table - Perceived Ease Of Use: Majority of students found online learning more difficult than consulting library.Listening to lectures online was troublesome for majority of students, moreover students also faced difficulty in expressing their thoughts during composing and attempting online E-learning assignments and submissions.Most students disagreed with the statement that they were quick while using web for E learning as depicted in  Attitude Towards E-Learning (AT): 49.7% students strongly disagreed with the idea of online learning as shown in the Fig- 1 and 40% suggested that online learning should be discouraged as given in Fig- 2 revealing our medical students to have negative attitude toward online learning.

DISCUSSION
The current study was planned to assess the perception of students of FJMU about E-learning during Covid-19 pandemic.
Our study showed that the majority of our students used mobile phones for e-learning and preferred zoom platform for learning followed by Microsoft teams.Many studies also showed preference of mobile phone for online learning in students 16,17,18 , the reason being the easy interaction at mobile and easy to carry anywhere..
In our country, online learning is going on in many institutions even before COVID 19, students had different opinions regarding e-learning, some preferred while others rejected this system.A study conducted in nursing students highlighted that nursing students preferred to adopt online learning 23 , while in our study, 72% of our students preferred face to face learning.Thus the majority of students around the globe are not in favor of online learning.Our study has also highlighted the major stressors that might be the reason for rejecting online learning.These included inadequate training, lack of information technology skills and poor internet connection, the same stressors have also been noted in study conducted in India 24 .By overcoming these stresses, online learning acceptability may be increased and this online system can be adopted in a better way, if its need arises again in future.
CONCLUSION E-learning system was not digestible for medical student of FJMU during COVID19 pandemic lock down period.The University should take measures to overcome the stressors of e-learning well in time so that students learning isn't affected if a similar situation arises.

Table - 1:General characteristics of study population Perceived Usefulness of E-Learning(PU):
1. Majority of the medical students thought that online learning improves the access to the learning materials.Students strongly disagreed to the better engagement of students in learning.Students thought that this online learning is much time consuming and less interactive among students and teachers.Overall this learning system impacted the respondents less as compared to face to face learning as shown in Table-2.

Table - 4: Stressors of E-learning Fig-3: Showing Intention Of Students To Use E- Learning
Table-4.
12jority of students had negative views like E-learning has little impact, is time consuming and less engaging, this is in line with many studies round the world like Poland19, Saudi Arabia20and India 21 etc.One study conducted in Liaquat College of Medicine and Dentistry in our country also highlighted that 77% of medical students had negative perception for e-learning during COVID 19 pandemic12.Another study conducted by Ansar et.al. in 10 different medical, engineering and arts institutions also concluded that 81% of students didn't want to continue with elearning