Abstract
Objectives
The aim of the study was to evaluate the attitude and perspectives of dental students of four Croatian universities towards online learning during the COVID-19 pandemic.
Material and methods
An anonymous internet-based survey was administered to undergraduate dental medicine students at the Universities of Zagreb, Rijeka, Split and Osijek. The 29-item questionnaire collected data on students’ demographics, online learning organization and management, and perception of online classes.
Results
Five hundred and four participants (85.1% female) took part in the survey. The majority of the participants (63.5%) were from the University of Zagreb. 39.6% of students reported agreement regarding online learning satisfaction. Individual university satisfaction ratings on overall online learning were: Osijek 3.69, Zagreb 3.22, Split 3.05 and Rijeka 2.64. Most students considered that lectures (82.9%) and seminars (78.9%) could be successfully delivered in an online learning format. The online learning format cannot successfully deliver laboratory, preclinical, clinical practicals or clinical clerkship, as agreed by more than 80% of the total student sample. 60% of students consider online learning a valuable alternative to face-to-face instruction.
Conclusion
Online learning was highly praised for educational formats such as lectures and seminars, and was considered a useful substitute for conventional learning. Conventional practical courses cannot be substituted with online learning. Overall perspective about online learning was mixed among the students of four universities. The findings of the present study can serve to help individual universities address the shortcomings and reinforce the strengths of their OL programs.
Keywords: MeSH Terms: Distance Education, Dental Students, Dental Education, Author Keywords: COVID-19, Pandemics, Online Learning, Questionnaires
Introduction
Shortly after the first case of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) which emerged in the Republic of Croatia (1), a set of public health measures was established on March 13, 2020. The suspension of on-site classes at all levels of education introduced remote learning, which was carried out until the end of the academic year (1). Due to the novelty of the virus and the uncertainties of viral transmission, the delivery of clinical classes was clearly not recommended, posing an unprecedented challenge in medical and dental education (2).
Online learning (OL), synonymous with distance learning and e-learning, appeared as a result of the digitalization of education in the past three decades. It has become increasingly popular as a form of education due to the space and time flexibility it offers and due to relatively reduced costs. At the same time, it may pose a challenge in terms of students’ attention maintenance and adherence, the need for teachers’ education in online tools and platforms, and material preparation (3, 4).
“Merlin”, based on the open source Moodle system and maintained by the University of Zagreb University Computing Center (SRCE), is the most widely used OL system in Croatia. Merlin and various conference call-based platforms enable theoretical content teaching. However, during the COVID-19 pandemic, universities faced challenges in addressing the appropriate delivery of practical content and hands-on courses, i.e. laboratory, preclinical and clinical courses (5).
This study aimed to evaluate the attitudes of dental students towards e-learning during the initial COVID-19 outbreak, their assessment of various types of course delivery (theoretical vs. practical) and compare the results obtained at four universities in Croatia that have an undergraduate program in Dental Medicine.
Material and methods
Study design and study population
This study was designed as an observational, cross-sectional, multi-institutional study conducted using an internet-based questionnaire.
The study population consisted of undergraduate dental medicine students from four Croatian universities, University of Zagreb (UniZg), University of Rijeka (UniRi), University of Split (UniSt) and University of Osijek (UniOs), enrolled in the academic year 2019/2020. All universities have a similar six-year undergraduate dental medicine program. Thereof, students of all six years were enrolled in the study, except for the UniOs. In the academic year 2019/2020, the most senior student generation at the UniOs, the last founded undergraduate dental medicine program in Croatia, was in its fourth year.
Questionnaire design
A new questionnaire was designed for the purpose of this study, as at the study’s inception, since no appropriate questionnaires were available in the literature. It was developed by five senior researchers with previous experience in questionnaire development and/or COVID-19 research and two undergraduate students. The questionnaire consisted of three parts, with a total of 29 questions. The first part (questions 1 - 4) aimed to collect participants’ general and personal information. The second part consisted of questions on online learning organization and management (questions 5 - 22), while the third part evaluated the perception of online classes (questions 23 - 29). The questions were in multiple choice and rating (Likert scale) format, with the latter ranging from 1 (strongly agree) to 5 (strongly disagree).
The questionnaire was prepared for distribution using the Google Forms platform and was disseminated by email through a dedicated link. E-mail addresses provided to the researchers by each university’s student representatives were authorized for such use. The questionnaire was distributed in June 2020, following the end of active classes in the summer semester. After the initial call for participation, a reminder was sent after one week. The questionnaire was open for access for two weeks in total.
Ethical considerations
This research was part of a student research project. It was approved by the Ethics Committee of the School of Dental Medicine of the University of Zagreb (number: 05-PA-30-XVI-4/2020).
Study information was provided in digital format upon entering the questionnaire through the dedicated link. Furthermore, the questionnaire could not be accessed before digital informed consent was obtained from the participants. Participation in the research was voluntary and anonymous. No monetary or non-monetary compensation was provided for participation.
Data analysis
Responses “completely agree” and “agree” were considered an agreement and a positive attitude, while “disagree” and “completely disagree” were considered to be a disagreement and a negative attitude. The collected data were entered into a data processing program (Microsoft Office Excel). Furthermore, categorical data were analyzed with a chi-square test. One-way ANOVA was used to analyze continuous data with additional Bonferroni post-hoc tests between groups. Non-parametric correlation analysis (Kendall) was used to analyze the relationship between variables of positive attitudes and age, gender and year of study. All p values below 0.05 were considered significant. IBM SPSS version 26.0.0.1 was used for all statistical procedures.
Results
The study included 504 participants, of which 85.1% were female. The majority of the participants (63.5%) were from UniZg. Participants from all four universities were almost equally distributed over years of study, except UniOs which at the time had enrolled students from year one to four (Figure 1).
Figure 1.
_395-404-f1.jpg)
The number of students per participating university
The results indicate that students generally used two major platforms for e-learning during the pandemic: online-learning system Merlin, and conference call-type platforms (e.g. Zoom, Skype, Google Hangouts) used for either small (up to 10 students) or large (more than 10 students) groups (Figure 2). Conference call-type platforms were used more than online-learning systems at UniZg (67.8%) and UniRi (51.4%). Conversely, students from UniSt and UniOs mostly used Merlin, 76.4% and 67.5%, respectively.
Figure 2.
_395-404-f2.jpg)
Platforms used for online learning
Detailed data are presented in Tables 1 and 2. Table 1 presents the attitudes of the overall student sample, rated on a 5-item Likert scale. Table 2 highlights the positive and negative attitudes of students of each university and the differences among them.
Table 1. Overall student population attitudes.
| Q# | Attitude | Level of agreement - N(%) | ||||
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | ||
| Organisation and management of OL | ||||||
| Q9 | I'm satisfied with OL so far | 46 (9.1%) |
154 (30.5%) |
143 (28.4%) |
118 (23.4%) |
43 (8.5%) |
| Q10 | I believe lectures can be successfully delivered in OL format | 224 (44.4%) |
194 (38.5%) |
47 (9.3%) |
27 (5.4%) |
12 (2.4%) |
| Q11 | I believe seminars can be successfully delivered in OL format | 158 (31.4%) |
240 (47.6%) |
56 (11.1%) |
37 (7.3%) |
13 (2.6%) |
| Q12 | I believe lab. practicals can be successfully delivered in OL format | 7 (1.4%) |
20 (4.0%) |
59 (11.7%) |
231 (45.8%) |
187 (37.1%) |
| Q13 | I believe preclin. practicals can be successfully delivered in OL format | 5 (1.0%) |
20 (4.0%) |
63 (12.4%) |
208 (41.3%) |
208 (41.3%) |
| Q14 | I believe clin. practicals can be successfully delivered in OL format | 5 (1.0%) |
5 (1.0%) |
30 (5.9%) |
169 (33.5%) |
295 (58.6%) |
| Q15 | I believe clin. clerkship can be successfully delivered in OL format | 7 (1.4%) |
4 (0.8%) |
29 (5.8%) |
170 (33.7%) |
294 (58.3%) |
| Q16 | During this period of OL I have discovered new online information and literature sources | 42 (8.2%) |
217 (43.1%) |
130 (25.8%) |
85 (16.9%) |
30 (6.0%) |
| Q17 | This modality of learning requires more time and dedication to the educational material | 147 (29.2%) |
208 (41.3%) |
104 (20.6%) |
40 (7.9%) |
5 (1.0%) |
| Q18 | There will be no need for the compensation of lost clinical practicals | 6 (1.1%) |
18 (3.6%) |
85 (16.9%) |
202 (40.1%) |
193 (38.3%) |
| Q19 | There will be no need for the compensation of lost clinical clerkship | 7 (1.4%) |
13 (2.6%) |
73 (14.5%) |
207 (41.1%) |
204 (40.4%) |
| Q20 | I feel well prepared for sitting exams after this period of OL | 30 (5.9%) |
128 (25.4%) |
166 (32.9%) |
122 (24.2%) |
58 (11.5%) |
| Q21 | I feel well prepared for working with patients after this period of OL | 12 (2.4%) |
26 (5.1%) |
109 (21.6%) |
172 (34.1%) |
185 (36.7%) |
| Q22 | I feel well prepared for working independently as a clinician after this period of OL (6th year*) | 7 (7.4%) |
7 (7.4%) |
17 (18.1%) |
29 (30.9%) |
34 (36.2%) |
| Perception of online classes | ||||||
| Q23 | I consider OL useful as an substitute to CL | 44 (8.7%) |
158 (31.3%) |
134 (26.6%) |
129 (25.6%) |
39 (7.7%) |
| Q24 | I consider OL useful as an addition to CL | 100 (19.8%) |
292 (57.9%) |
59 (11.7%) |
40 (7.9%) |
13 (2.6%) |
| Q25 | OL can NOT be an adequate substitute for clinical formats (clin. practicals and clerkship) | 349 (69.2%) |
115 (22.8%) |
14 (2.8%) |
9 (1.8%) |
17 (3.4%) |
| Q26 | There is further need for improvement of OL formats | 170 (33.7%) |
255 (50.6%) |
64 (12.7%) |
13 (2.6%) |
2 (0.4%) |
| Q27 | Teachers were well prepared for execution of OL | 53 (10.5%) |
181 (35.9%) |
148 (29.4%) |
84 (16.7%) |
38 (7.5%) |
| Q28 | I was well prepared for execution of OL | 60 (11.9%) |
239 (47.4%) |
159 (31.5%) |
39 (7.7%) |
7 (1.5%) |
| N - frequency; % - percentage; Q - question; OL - online learning; CL - conventional learning | ||||||
Table 2. Positive (“strongly agreeing” + “agreeing”) and negative (“strongly disagreeing” + “disagreeing”) attitudes of students.
| Attitude | University - N(%) | p | |||||
|---|---|---|---|---|---|---|---|
| Zagreb | Split | Rijeka | Osijek | ||||
| Q# | Organisation and management of OL | ||||||
| Q9 | I'm satisfied with OL so far | Negative | 182 (56.9%) | 53 (73.6%) | 56 (77.8%) | 13 (32.5%) | <0.001 |
| Positive | 138 (43.1%) | 19 (26.4%) | 16 (22.2%) | 27 (67.5%) | |||
| Q10 | I believe lectures can be successfully delivered in OL format | Negative | 32 (10.0%) | 26 (36.1%) | 21 (29.2%) | 7 (17.5%) | <0.001 |
| Positive | 288 (90.0%) | 46 (63.9%) | 51 (70.8%) | 33 (82.5%) | |||
| Q11 | I believe seminars can be successfully delivered in OL format | Negative | 48 (15.0%) | 26 (36.1%) | 23 (31.9%) | 9 (22.5%) | <0.001 |
| Positive | 272 (85.0%) | 46 (63.9%) | 49 (68.1%) | 31 (77.5%) | |||
| Q12 | I believe lab. practicals can be successfully delivered in OL format | Negative | 300 (93.8%) | 70 (97.2%) | 68 (94.4%) | 39 (97.5%) | 0.552 |
| Positive | 20 (6.3%) | 2 (2.8%) | 4 (5.6%) | 1 (2.5%) | |||
| Q13 | I believe preclin. practicals can be successfully delivered in OL format | Negative | 304 (95.0%) | 70 (97.2%) | 66 (91.7%) | 39 (97.5%) | 0.395 |
| Positive | 16 (5.0%) | 2 (2.8%) | 6 (8.3%) | 1 (2.5%) | |||
| Q14 | I believe clin. practicals can be successfully delivered in OL format | Negative | 313 (97.8%) | 71 (98.6%) | 70 (97.2%) | 40 (100.0%) | 0.743 |
| Positive | 7 (2.2%) | 1 (1.4%) | 2 (2.8%) | 0 (0.0%) | |||
| Q15 | I believe clin. clerkship can be successfully delivered in OL format | Negative | 314 (98.1%) | 70 (97.2%) | 69 (95.8%) | 40 (100.0%) | 0.479 |
| Positive | 6 (1.9%) | 2 (2.8%) | 3 (4.2%) | 0 (0.0%) | |||
| Q16 | During this period of OL I have discovered new online information and literature sources | Negative | 135 (42.2%) | 40 (55.6%) | 47 (65.3%) | 23 (57.5%) | 0.001 |
| Positive | 185 (57.8%) | 32 (44.4%) | 25 (34.7%) | 17 (42.5%) | |||
| Q17 | This modality of learning requires more time and dedication to the educational material | Negative | 87 (27.2%) | 25 (34.7%) | 18 (25.0%) | 19 (47.5%) | 0.034 |
| Positive | 233 (72.8%) | 47 (65.3%) | 54 (75.0%) | 21 (52.5%) | |||
| Q18 | There will be no need for the compensation of lost clinical practicals | Negative | 305 (95.3%) | 70 (97.2%) | 69 (95.8%) | 36 (90.0%) | 0.376 |
| Positive | 15 (4.7%) | 2 (2.8%) | 3 (4.2%) | 4 (10.0%) | |||
| Q19 | There will be no need for the compensation of lost clinical clerkship | Negative | 310 (96.9%) | 71 (98.6%) | 66 (91.7%) | 37 (92.5%) | 0.080 |
| Positive | 10 (3.1%) | 1 (1.4%) | 6 (8.3%) | 3 (7.5%) | |||
| Q20 | I feel well prepared for sitting exams after this period of OL | Negative | 211 (65.9%) | 53 (73.6%) | 61 (84.7%) | 21 (52.5%) | 0.001 |
| Positive | 109 (34.1%) | 19 (26.4%) | 11 (15.3%) | 19 (47.5%) | |||
| Q21 | I feel well prepared for working with patients after this period of OL | Negative | 290 (90.6%) | 68 (94.4%) | 69 (95.8%) | 39 (97.5%) | 0.205 |
| Positive | 30 (9.4%) | 4 (5.6%) | 3 (4.2%) | 1 (2.5%) | |||
| Q22 | I feel well prepared for working independently as a clinician after this period of OL | Negative | 53 (16.6%) | 10 (13.9%) | 15 (20.8%) | 2 (5.0%) | 0.158 |
| Positive | 267 (83.4%) | 62 (86.1%) | 57 (79.2%) | 38 (95.0%) | |||
| Perception of online classes | |||||||
| Q23 | I consider OL useful as an substitute to CL | Negative | 176 (55.0%) | 53 (73.6%) | 57 (79.2%) | 16 (40.0%) | <0.001 |
| Positive | 144 (45.0%) | 19 (26.4%) | 15 (20.8%) | 24 (60.0%) | |||
| Q24 | I consider OL useful as an addition to CL | Negative | 58 (18.1%) | 21 (29.2%) | 23 (31.9%) | 10 (25.0%) | 0.026 |
| Positive | 262 (81.9%) | 51 (70.8%) | 49 (68.1%) | 30 (75.0%) | |||
| Q25 | OL can NOT be an adequate substitute for clinical formats (clin. practicals and clerkship) | Negative | 27 (8.4%) | 4 (5.6%) | 4 (5.6%) | 5 (12.5%) | 0.500 |
| Positive | 293 (91.6%) | 68 (94.4%) | 68 (94.4%) | 35 (87.5%) | |||
| Q26 | There is further need for improvement of OL formats | Negative | 53 (16.6%) | 8 (11.1%) | 9 (12.5%) | 9 (22.5%) | 0.350 |
| Positive | 267 (83.4%) | 64 (88.9%) | 63 (87.5%) | 31 (77.5%) | |||
| Q27 | Teachers were well prepared for execution of OL | Negative | 164 (51.3%) | 47 (65.3%) | 52 (72.2%) | 7 (17.5%) | <0.001 |
| Positive | 156 (48.8%) | 25 (34.7%) | 20 (27.8%) | 33 (82.5%) | |||
| Q28 | I was well prepared for execution of OL | Negative | 119 (37.2%) | 38 (52.8%) | 37 (51.4%) | 11 (27.5%) | 0.006 |
| Positive | 201 (62.8%) | 34 (47.2%) | 35 (48.6%) | 29 (72.5%) | |||
| Chi-square test N - frequency; % - percentage; Q - question; OL - online learning; CL - conventional learning; P - significance level | |||||||
39.6% of students reported agreement regarding OL satisfaction, followed by 31.9% of those disagreeing and 28.4% of neutral respondents. UniOs students had significantly greater positive attitudes than other universities (67.5%, p<0.001).
Most students agreed that lectures (82.9%) and seminars (78.9%) could be conducted in OL format. UniZG students had significantly more positive attitudes, 90% for lectures and 85% for seminars (p>0.001). More than 80% of the total student sample disagreed that OL is the format for successfully delivering laboratory, preclinical, clinical practicals or clinical clerkship, respectively.
Almost half of the students agreed to have discovered new online information and literature sources in the period of OL. UniRi students have meanwhile reported significantly more negative attitudes, with 65.3% reporting disagreement with the statement that they have found new information sources (p=0.001). 70.5% of the overall sample agreed that OL as a learning modality requires more time and is effort-consuming, with UniRi students, 75.0% (p=0.034) reporting significantly higher level of agreement.
Around 80% of students disagreed that there would be no compensation needed for clinical practicals and clinical clerkship, respectively. Similarly, almost 70% of sixth-year students disagreed that they feel well prepared for independent clinical work following the period of OL.
Similar rates of students, that is one third, reported agreeing and disagreeing with being well-prepared for sitting exams after the OL period. UniRi students, 84.7% (p=0.001), reported significantly more negative attitudes and disagreed to a greater extent with this statement.
40% of the overall sample considered OL a good substitute for conventional learning. UniOs students were the only ones reporting positive attitudes, with 60% (p<0.001) of them agreeing with the statement. 77.7% of the overall sample agreed OL is only a good alternative for conventional learning, with UniZg students exhibiting a significantly more positive attitude (81.9%, p=0.026). 92% of all students agreed that OL could not substitute clinical education formats.
The overall sample generally agreed that both the teaching staff and the students were well-prepared for OL, 46.4% and 50.3%, respectively. UniOs students were reporting significantly more positive attitudes for both statements, 82.5% (p<0.001) and 72.5% (p=0.006), respectively. 84.3% of all students agreed that there is a further need for improvement of OL.
Overall OL satisfaction was also rated by the total student sample as follows: 1 – 6.5%, 2 – 17.5%, 3 – 37.9%, 4 – 30.6% and 5 – 7.5%. Individual university ratings were: UniOs 3.69, UniZg 3.22, UniSt 3.05 and UniRi 2.64 (Figure 3).
Figure 3.
_395-404-f3.jpg)
OL satisfaction rating of individual universities
An analysis of the correlation between positive attitudes and specific determinants such as age, female gender and year of study showed some statistical significance but with mostly weak Kendall’s correlation coefficient (Table 3).
Table 3. Correlation of positive attitudes and age, students’ gender and year of study.
| Q# | Attitudes | Age | Female gender | Study year |
|---|---|---|---|---|
| Organisation and management of OL | ||||
| Q10 | Success of OL format of lecture | 0.184 (<0.001) | 0.047 (0.287) | 0.149 (<0.001) |
| Q11 | Success of OL format of seminars | 0.158 (<0.001) | 0.071 (0.109) | 0.124 (0.002) |
| Q12 | Success of OL format of lab. practicals | 0.097 (0.013) | -0.024 (0.586) | 0.057 (0.150) |
| Q13 | Success of OL format of preclin. practicals | 0.132 (0.001) | 0.018 (0.678) | 0.120 (0.002) |
| Q14 | Success of OL format of clin. practicals | 0.123 (0.002) | -0.020 (0.646) | 0.120 (0.002) |
| Q15 | Success of OL format of clin. clerkship | 0.079 (0.043) | -0.014 (0.756) | 0.075 (0.058) |
| Q16 | Discovery of new online sources | 0.088 (0.024) | 0.062 (0.166) | 0.108 (0.006) |
| Q17 | Requiring more time and dedication | -0.095 (0.015) | 0.108 (0.016) | -0.119 (0.003) |
| Q21 | Prepared for clinical work with patients | 0.192 (<0.001) | -0.050 (0.267) | 0.225 (<0.001) |
| Q22 | Prepared for independent clinical work | -0.406 (<0.001) | -0.014 (0.757) | -0.450 (<0.001) |
| Perception of online classes | ||||
| Q24 | OL as a useful addition to CL | 0.128 (0.001) | 0.031 (0.483) | 0.106 (0.007) |
| Values: Kendall’s rank correlation coefficient - τ_b (p-values) Q - question; OL - online learning; CL - conventional learning | ||||
Discussion
This study aimed to assess student attitudes and OL perceptions during the COVID-19 pandemic and compare them among the student population of four Croatian universities. The overall perception of OL and its segments was mixed and varied among students of different universities. Students generally agreed that the online delivery of lectures and seminars was satisfactory. Conversely, education formats that presume manual practice, i.e. laboratory, preclinical and clinical practices, could not be adequately performed and substituted in an online format.
The COVID-19 pandemic is undoubtedly one of the greatest public health crises in contemporary history, affecting all aspects of society. The most significant impact of COVID-19 on education has surely been a global switch towards OL concerning disease transmission reduction policies. OL has been implemented in higher education curricula far before the onset of the pandemic, however, with significant variability between countries and universities (6, 7). One of the countries at the forefront of online education, the United States, already had more than 30% of the nationwide student population enrolled in an online course in 2012 (8). In fact, the importance and value of OL have been long recognized by the US academic leaders, defining it as crucial for academic institutions’ long-term strategy (9). Even though the implementation of OL at the UniZg officially started in 2007 (10), only a smaller number of faculties conducted online courses before the pandemic (11). As the results obtained in the present study suggest, online teaching was primarily conducted using two types of remote learning systems: e-learning platforms such as Merlin (presuming asynchronous format) and various online applications for conference calls (presuming synchronous format). Teaching in Zagreb and Rijeka relied more on conference call-based applications, 67.8% and 51.4%, respectively. In Split and Osijek, e-learning platforms were mainly used, as reported by 76.4% and 67.5% of students, respectively. While synchronous learning is recognised for enabling direct communication and interactivity, the asynchronous learning format allows for time and space flexibility and collaborative work. Schlenz et al. reported that 54.3% of teachers at a German dental school used synchronous learning formats in the same time frame as the present study, and very little, 5.7% used asynchronous format (12). A possible explanation for this observation could be the low rate (14.3%) of teachers’ experience with OL and the need to prepare teaching materials. Hannon et al., however, highlighted online e-learning platforms, asynchronous format, for their value and role as predominant mediums for theoretical learning (13). A study comparing the two learning formats highlighted that students, in fact, prefer the asynchronous learning format (14).
More than 90% of the total sample agreed that OL could not replace any type of practical course. Furthermore, almost 80% disagreed that there would be no need for compensation for clinical training hours. These findings are in line with previous research on the impact of COVID-19 on dental and medical education (12, 15–17). Students also reported anxiety about losing their dexterity skills due to the loss of preclinical and clinical hours (18–20). In fact, 70.8% of students in the present study stated that they felt unprepared for clinical hours, while 71.1% of the 6th-year students did not feel prepared for independent clinical work following graduation. Lack of regular manual training classes could be bypassed by specific learning formats, such as video format, online tutorials or even an online hands-on course, as described by Oetter et al. (21). The authors reported on a highly praised mixed theoretical-practical course, promoting the learning of surgical techniques on easily accessible models such as bananas or meat with concomitant live demonstration.
Finally, students from Zagreb and Osijek reported the greatest satisfaction with OL, 58.6% and 67.5%, respectively. On the other hand, around 45% of students in both Split and Rijeka reported disagreement and complete disagreement with satisfaction regarding the organization of OL, followed by around 30% of neutral respondents. In 2010 and 2011, Brumini et al. conducted a survey-based study on dental students from Zagreb, Rijeka and Split and their attitudes towards OL and reported a generally positive attitude among students of all three universities. At the time, however, almost half of the attendees have not been following online classes. In fact, the positive attitudes were determined by the greater use of the Internet, Facebook and the number of online classes (22), since dental students in Croatia previously reported online platforms were not represented properly in the study program (23).
One of the limitations of the current study is that the students from different universities were unevenly distributed within the total sample. The greatest number of participants, 63.5%, included the students from the UniZg. This may be explained by the fact that in terms of enrollment numbers, the study program at the School of Dental Medicine in Zagreb allows for the enrollment of the greatest number of students. It can also be expected that Zagreb students exhibited a greater likeliness for study participation due to their familiarity with the research team. It is also worth highlighting that the student sample from the UniOs consisted only of preclinical students. Given that students of other universities highly criticized the absence of practical courses, this could explain the generally greatest satisfaction of UniOs’s students with OL.
This study is the first to include undergraduate dental medicine students from all four university programs in Croatia. As such, it provides invaluable insight into the nationwide student experience during the COVID-19 pandemic. Despite the similarities between the dental curricula in all four universities, some differences in the overall satisfaction among the students were observed. The findings of this study could serve as a basis for informed decisions of individual undergraduate program leaders on the improvement of OL. Unfortunately, the study’s cross-sectional design prevents the researchers from following up on student perception changes in the pandemic’s later stages. As of September 2020, education in dental medicine programs has switched partially and, in 2021, almost exclusively back to face-to-face education. Nonetheless, the authors of this study believe that data from this and similar studies should be implemented to improve (future) OL and incorporate it into a hybrid education approach. In fact, based on this study, the best-evaluated formats of online education, lectures and seminars should be considered mainstream education forms in the future.
Conclusions
OL has proven itself as an invaluable tool for university-level education during the COVID-19 pandemic, especially for learning formats such as lectures and seminars. However, OL cannot substitute all educational formats, especially those dedicated to dental medicine students. Dental medicine education presumes not only acquiring new theoretical knowledge but also manual skills and clinical competencies, the perceived value of which was strongly highlighted in the present study by reported student attitudes. Overall student satisfaction was mixed, as well as students’ attitudes and experiences with particular aspects of OL. The findings of the present study can help individual universities address the shortcomings and reinforce the strengths of their OL programs.
Footnotes
Conflict of Interest
The authors have no conflicts of interest to declare.
Funding
The authors declare that this study received no funding.
References
- 1.Ministarstvo znanosti i obrazovanja. Dodatne upute vezane uz obustavu nastave na visokim učilištima [Internet] 2022 [cited 2022 Sep 20]. Available from: https://mzo.gov.hr/UserDocsImages/dokumenti/Vijesti/2020/Dodatn20upute%20vezano%20uz%20obustavu%20nastave%20na%20visokim%20ucilistima%20-%2013.%203.%202020.pdf
- 2.Brkić H. Dental medicine and COVID-19 pandemic. Acta Stomatol Croat. 2020. June;54(2):118–20. [PMC free article] [PubMed] [Google Scholar]
- 3.Schönwetter DJ, Reynolds PA, Eaton KA, De Vries J. Online learning in dentistry: an overview of the future direction for dental education. J Oral Rehabil. 2010. December;37(12):927–40. 10.1111/j.1365-2842.2010.02122.x [DOI] [PubMed] [Google Scholar]
- 4.Quinn BFA. Challenges and opportunities of online education in dentistry post-COVID-19. Br Dent J. 2022;233(6):491. 10.1038/s41415-022-4979-y [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Rose S. Medical Student Education in the Time of COVID-19. JAMA. 2020. June 2;323(21):2131. 10.1001/jama.2020.5227 [DOI] [PubMed] [Google Scholar]
- 6.Garrison DR. E-Learning in the 21st Century: A Framework for Research and Practice. 2nd ed. New York: Routledge; 2011. pp.184. [Google Scholar]
- 7.Cheng YM. Antecedents and consequences of e-learning acceptance. Inf Syst J. 2011;21(3):269–99. 10.1111/j.1365-2575.2010.00356.x [DOI] [Google Scholar]
- 8.Allen E, Seaman J. Changing Course: Ten Years of Tracking Online Education in the United States [Internet]. Babson Survey Research Group and Quahog Research Group, LLC; 2013. Available from: https://www.bayviewanalytics.com/reports/changingcourse.pdf
- 9.Kentnor H. Distance Education and the Evolution of Online Learning in the United States. Curric Teach Dialogue. 2015;17(1–2):21–34. [Google Scholar]
- 10.Povjerenstvo za izradu strategije e-učenja Sveučilišta u Zagrebu. Strategija e-učenja 2007.-2010. [Internet]. 2017 [cited 2022 Sep 20]. Available from: http://www.unizg.hr/fileadmin/rektorat/Studiji_studiranje/Studiji/e-ucenje/e-ucenje_strategija/Sveuciliste_u_Zagrebu_Strategija_e_ucenja_Senat_v1.pdf
- 11.Bušljeta Kardum R, Jurić Vukelić D. The Challenges and Issues on the University of Zagreb during COVID-19 Crisis. Interdiscip Descr Complex Syst. 2021. September 30;19(3):357–65. 10.7906/indecs.19.3.1 [DOI] [Google Scholar]
- 12.Schlenz MA, Schmidt A, Wöstmann B, Krämer N, Schulz-Weidner N. Students’ and lecturers’ perspective on the implementation of online learning in dental education due to SARS-CoV-2 (COVID-19): a cross-sectional study. BMC Med Educ. 2020. October 9;20(1):354. 10.1186/s12909-020-02266-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Haroon Z, Azad AA, Sharif M, Aslam A, Arshad K, Rafiq S. COVID-19 Era: Challenges and Solutions in Dental Education. J Coll Physicians Surg--Pak JCPSP. 2020 Oct;30(10):129–31. [DOI] [PubMed]
- 14.Goob J, Erdelt K, Güth JF, Liebermann A. Dental education during the pandemic: Cross-sectional evaluation of four different teaching concepts. J Dent Educ. 2021. October;85(10):1574–87. 10.1002/jdd.12653 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Iosif L, Ţâncu AMC, Didilescu AC, Imre M, Gălbinașu BM, Ilinca R. Self-Perceived Impact of COVID-19 Pandemic by Dental Students in Bucharest. Int J Environ Res Public Health. 2021. January;18(10):5249. 10.3390/ijerph18105249 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Badovinac A, Par M, Plančak L, Balić MD, Vražić D, Božić D, et al. The Impact of the COVID-19 Pandemic on Dental Education: An Online Survey of Students’ Perceptions and Attitudes. Dent J (Basel). 2021. October;9(10):116. 10.3390/dj9100116 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Hattar S, AlHadidi A, Sawair FA, Alraheam IA, El-Ma’aita A, Wahab FK. Impact of COVID-19 pandemic on dental education: online experience and practice expectations among dental students at the University of Jordan. BMC Med Educ. 2021. March 8;21(1):151. 10.1186/s12909-021-02584-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Agius AM, Gatt G, Vento Zahra E, Busuttil A, Gainza-Cirauqui ML, Cortes ARG, et al. Self-reported dental student stressors and experiences during the COVID-19 pandemic. J Dent Educ. 2021;85(2):208–15. 10.1002/jdd.12409 [DOI] [PubMed] [Google Scholar]
- 19.Hung M, Licari FW, Hon ES, Lauren E, Su S, Birmingham WC, et al. In an era of uncertainty: Impact of COVID-19 on dental education. J Dent Educ. 2021. February;85(2):148–56. 10.1002/jdd.12404 [DOI] [PubMed] [Google Scholar]
- 20.Adam M, Urbančič-Rak T, Crnić T. Dental Students’ Discomfort and Anxiety During the First and the Second Lockdown Due to COVID-19 Pandemic at the School of Dental Medicine, University of Zagreb. Acta Stomatol Croat. 2021. June;55(2):186–97. 10.15644/asc55/2/8 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Oetter N, Möst T, Weber M, Buchbender M, Rohde M, Foerster Y, et al. COVID-19 pandemic and its impact on dental education: digitalization – progress or regress? Example of an online hands-on course. BMC Med Educ. 2022. August 1;22(1):591. 10.1186/s12909-022-03638-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Brumini G, Spalj S, Mavrinac M, Biočina-Lukenda D, Strujić M, Brumini M. Attitudes towards e-learning amongst dental students at the universities in Croatia. Eur J Dent Educ. 2014. February;18(1):15–23. 10.1111/eje.12068 [DOI] [PubMed] [Google Scholar]
- 23.Batra M, Ivanišević Malčić A, Shah AF, Sagtani RA, Medvedec Mikić I, Tariba Knežević P, et al. Self Assessment of Dental students’ Perception of Learning Environment in Croatia, India and Nepal. Acta Stomatol Croat. 2018. December;52(4):275–85. 10.15644/asc52/4/1 [DOI] [PMC free article] [PubMed] [Google Scholar]