ISSN: 2320-5407 Int. J. Adv. Res.

12(01), 1320-1330

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/18256

DOI URL: http://dx.doi.org/10.21474/IJAR01/18256

RESEARCH ARTICLE
MEDICAL STUDENTS’ PERSPECTIVE ON THE TEACHINGPROCESS OF RADIOLOGY DURING
AND AFTER THECOVID-19 PANDEMIC

Yahea Abdullah Alzahrani

Associate Professor of Radiology, Internal Medicine Department, College of Medicine, Taif University, Kingdom of
Saudi Arabia.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Background: Over the last few years, radiology teaching and training
Received: 30 November 2023 have transformed from traditional lectures to early team-based clinical
Final Accepted: 31 December 2023 learning and case-based teaching.
Published: January 2024 Objectives: To assess the perspective of undergraduate medical
students regarding radiology teaching during and after the coronavirus
Key words:-
E-Learning, Radiology, Perception, disease 2019 (COVID-19)pandemic.
COVID-19, Saudi Arabia Subjects and methods: A cross-sectional study was conducted among
undergraduate medical students from third year to interns enrolled in
Taif University for the academic year 2023-2024. An online, self-
administered questionnaire was utilized for data collection. It contains
20 questions divided into three sections: I) general information and
students' demographic data (4 questions); II) questions related to the
student's teaching-learning experiences after the COVID-19 pandemic
period (8 questions); and III) questions related to the student's teaching-
learning experiences in the COVID-19 pandemic period (8 questions).
Results: A total of 204 students were included in the study. They were
equally distributed according to their gender and almost equally
distributed according to their academic year. The majority (86.3%) of
them used tablets as the primary device for e-learning during and after
the COVID-19 pandemic. Significant improvements were observed in
the perspective of the participants regarding the quality of on-site
radiology teaching (p<0.001), their performance in on-site
radiologyteaching (p=0.007), and thoughts related to radiology
teaching via e-learning (p=0.023) after the COVID-19 pandemic
compared to it during the pandemic.
Conclusion:Medical students generally view radiology education
positively after the pandemic. However, improvements in the structures
and assessments of both online and onsite radiology teaching are
needed. Interestingly, female students found e-learning and assessments
more valuable, while older students appreciated the overall structure
more.

Copy Right, IJAR, 2024,. All rights reserved.

……………………………………………………………………………………………………....

Corresponding Author:- Yahea Abdullah Alzahrani

Address:- Associate Professor of Radiology, Internal Medicine Department,
College of Medicine, Taif University, Kingdom of Saudi Arabia. 1320
ISSN: 2320-5407 Int. J. Adv. Res. 12(01), 1320-1330

Introduction:-
Recent studies have insisted on the importance of radiology teaching for undergraduate medical students [1-3]. Over
the last years, radiology teaching and training have transformed from traditional lectures to early team-based clinical
learning and case-based teaching [4].

Like most other medical specialties, e-learning has proved to be a highly effective tool in radiology education and
teaching, even before the pandemic of coronavirus disease 2019 (COVID-19) [2, 5].

Radiology e-learning has been extensively used in radiology teaching and training in the majority of European
medical schools in recent years [6]. It has been observed that a combination of onsite face-to-face andonline e-
learning successfully promoted students' knowledge and skills in basic and clinical radiology [7].

Undergraduate medical students often receive insufficient teaching input and are insufficiently trained in basic
radiology [8, 9]. Basic and clinical radiology should be integrated into the medical curriculum due to the widespread
use of medical images in clinical practice. This empowers students with image interpretation skills and the
knowledge to seek expert radiological guidance when needed[7].

Several studies reported that even in specialized centers within the United States of America [10, 11] and the United
Kingdom [8, 12], teaching radiology to undergraduate medical students is still very insufficient. This highlights the
importance of radiology teaching and learning in undergraduate medical education, focusing on teaching image
interpretation skills and appropriate ordering of investigations, which should be associated with prospective clinical
practice [13]. The E-learning approach is limited by providing inadequate clinical experience to the students. Thus,
there is a need for more modern teaching methods to train students in radiology better [14].

The COVID-19 pandemic has changed radiology teaching from traditional practical image interpretation to online
tools that could enable proper teaching and even help students interact with image analysis. Therefore, it is
necessary to understand the medical student's perspective on the teaching process of radiology during and after the
COVID-19 pandemic to establish more effective teaching strategies in radiology.

The present study aims to assess the perspective of undergraduate medical students regarding the radiology teaching
process during and after the COVID-19 pandemic in one of Saudi Arabia's universities, which, to the best of our
knowledge, has not yet been reported.

Subjects and Methods:-

A cross-sectional design was conducted in Taif City, located in the western region of Saudi Arabia in Makkah
Province, with an estimated population of 683,000 (2019 estimated census) [15]. Taif City has one government
university (Taif University), including the College of Medicine. The study was conducted specifically at the College
of Medicine, Taif University. The target population was undergraduate medical students enrolled in Taif University
for the academic year 2023-2024, from third year to interns of both genders (approximately 430 students). Students
who transferred from other colleges or universities during the COVID-19 pandemic, those with a gap in their studies
during the pandemic, and those with insufficient attendance rates in the radiology lectures were excluded from the
study.

An online self-administered questionnaire was utilized for data collection. It has been used previously in a study
conducted among undergraduate medical students in Sao Paulo, Brazil [16]. Permission to use the questionnaire was
asked through an e-mail communication with the corresponding author. The questionnaire contains 20 questions
divided into three sections: I) General Information and students' demographic data (4 questions); II) questions
related to the student's teaching-learning experiences after the Covid-19 pandemic period (8 questions); and III)
questions related to the student's teaching-learning experiences in the Covid-19 pandemic period (8 questions).
Students were informed about the study's purpose and benefits before giving their consent to participate and answer
the questionnaire.

Assuming that 50% of undergraduate medical students perceived radiology teaching efficiently after COVID-19,
setting the confidence interval of 95% and sample error of 5%, using the Raosoft sample size calculator program,
the sample size calculation was 204 students, representing approximately 56% of the students. A stratified random

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sampling equal proportion technique was adopted to select 102 female and 102 male students. Within each gender,
the sample was equally distributed in different academic years (from third year to interns). A simple random
technique was adopted to select students from each stratum from a list of students obtained from the college
administration.

Statistical Package of Social Science SPSS, version 28, entered and analyzed the data. Descriptive statistics in the
form of frequencies and percentages were calculated to summarize categorical data. Chi-squared/Fischer Exact and
McNemar tests were used to evaluate the association between the determinants and the outcome variables and the
difference in students` perception during and after the COVID-19 pandemic. Any p-value < 0.05 was considered
statistically significant.

Results:-
A total of 204 students were included in the study. The majority of them (82.4%) were aged between 21 and 24
years. Equally distributed according to their gender and almost equally distributed according to their academic year.
Most of them (44.1%) had grade average points (GPA) between 3 and <4, whereas 38.7% had GPAs between 4 and
5. Table 1

Most participants (86.3%) used tablets as the main device for e-learning during and after the COVID-19 pandemic,
as seen in Figure 1.

Table 2 shows significant improvements in the perspective of the participants regarding the quality of on-site
radiology teaching (p<0.001), their performance in on-site radiology (p=0.007), and thoughts related to radiology
teaching via e-learning (p=0.023) after the COVID-19 pandemic compared to it during the pandemic.

Female students were more likely than males to consider radiology teaching via e-learning as very important (19.6%
vs. 6.9%), p=0.023. Similarly, females were more likely than males to describe the assessment system of radiology
teaching after the COVID-19 pandemic as very efficient (12.7% vs. 5.9%), p=0.005. Table 3

Older students (>24 years old) were more likely than younger students (21-24 years old) to describe the structure of
the radiology teaching after the COVID-19 pandemic as very good (27.8% vs. 13.1%), p=0.024. Table 4

The medical students in the pre-clinical years were more likely than those in the clinical years to consider on-site
radiology teaching as very good after the COVID-19 pandemic (25.9% vs. 7.6%), p=0.001. Table 5

Almost half of the students with a GPA of <4 (48.8%) described the quality of on-site radiology teaching after the
Covid-19 pandemic as good, whereas 16.8% of them described it as very good compared to 29.1% and 12.7%,
respectively, of students whose GPA was >4, p=0.020. Similarly, 44% of students with a GPA of <4 described the
structure of the radiology teaching after the Covid-19 pandemic as good, whereas 14.4% of them described it as very
good compared to 24.1% and 17.7%, respectively, of students whose GPA was >4, p=0.010. Students with a GPA of
<4 were more likely than those with a GPA>4 to rate the assessment system of radiology teaching after the COVID-
19 pandemic as very efficient (12% vs. 5.1%), p=0.018. Table 6

Discussion:-
Radiology educators usually face challenges in their job, including choosing adequate teaching time, financial
constraints, allocating educational needs, professional development, and having instruments to assess teaching
quality [17]. Therefore, depending on students' perceptions of learning experiences, it is considered a qualit y control
tool to evaluate the practical aspect of the teaching process in practice [16].

Traditional onsite face-to-face academic teaching has been suspended during the COVID-19 pandemic in almost all
worldwide medical schools to ensure social distancing and reduce the spread of COVID-19 infection among
students and teaching staff [18-20]. Also, disruption observed in the radiology academic programs, with its short-
term and long-term effects, is due to the COVID-19 pandemic [21, 22]. It has impacted the radiology teaching and
practice of undergraduate medical students and postgraduate residents and fellows [1].

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During the COVID-19 pandemic, e-teaching almost completely replaced traditional lectures and face-to-face
teaching, which continued in many places after the pandemic [23]. The question now is whether online teaching and
education will continue to be utilized in the long term or not.

The present study assessed the perspective of undergraduate medical students and interns regarding radiology
teaching and compared it during and after the COVID-19pandemic and showed significant improvements in the
perspective of the participants regarding the quality of on-site radiology teaching, their performance in on-site
radiology teaching, and thoughts related to radiology teaching via e-learning after the COVID-19 pandemic
compared to it during the pandemic.

In the current study, the majority of the students used tablets as the main device for e-learning during and after the
COVID-19 pandemic. Recent studies showed that the preferred learning device depended on age. At the same time,
older students were more likely to use desktops, and younger students tended to use tablets, notebooks, and
smartphones, with no difference between all these technologies regarding their usefulness during online teaching
activities [24].

Teaching in radiology should take more consideration from decision makers as it has been reported that radiology
faculty members spent 72% of their time performing clinical work and only 19% on radiology teaching-related
activities' furthermore, they spent more time in one-side teaching rather than interacting with students, which
negatively impacts students` critical thinking skills [25].Therefore, there is a need to provide more active and
encouraging interactions and assign more time for radiology teaching sessions.

This study revealed that older students (>24 years old) were more likely than younger students (21-24 years old) to
rate the structure of the radiology lectures after the COVID-19 pandemic. However, pre-clinical medical students
were more likely than those in clinical years to rate the on-site radiology teaching highly after the COVID-19
pandemic.These differences may be attributed to variations in academic experience, as older medical students
experienced more practical activities in their clinical years than others. Additionally, pre-clinical years students were
starting their clinical practice when they had to move to e-learning, which differed from their plans when they
enrolled in the radiology lectures.

Also, the present study showed that female students were more likely than males to consider the importance of
radiology teaching via e-learning and the efficiency of the assessment system of radiology teaching after the
COVID-19 pandemic. This is not surprising as it has been documented previously that females were more engaged
than males in online learning [26], and they have stronger self-regulation than males in online learning contexts [27].

It should be emphasized that the importance of e-teaching radiology is not because of the COVID-19 pandemic
period, as previous pandemic studies showed a significant role of online teaching strategies as effective methods
compared to traditional onsite face-to-face strategy [28]. Also, some others recommended a combination of online
and face-to-face teaching [29].

To the best of our knowledge, The present study is the first to explore medical students` perception of radiology
teaching changes due to the COVID-19 pandemic in one of Saudi Arabia's universities. However, some limitations
exist, including being a single university study, which could impact the ability to generalize the findings over other
universities in Saudi Arabia. Also, students' individual needs regarding their professional skills during the radiology
training course were not investigated.

Conclusion:-
Overall, the perception of medical students regarding radiology teaching after the COVID-19 pandemic is
promising. However, recommendations for improvement were identified in both the structure and assessment
methods across traditional on-site and e-learning modalities. Female students were more likely than males to
perceive the importance ofradiology teaching via e-learning and the effectiveness of the assessment system of
radiology teaching after the COVID-19 pandemic. In contrast, older students were more likely than younger students
to perceive the structure of the radiology teaching after the COVID-19 pandemic. These findings suggest the
potential benefit of tailoring teaching approaches to consider student demographics and preferences for optimized
learning outcomes.

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Table 1:- Demographic characteristics of the participants (n=204).

Variables Frequency Percentage
Age in years
21-24 168 82.4
>24 36 17.6
Gender
Male 102 50.0
Female 102 50.0
Academic year
3rd 44 21.6
th
4 41 20.1
th
5 38 18.6
th
6 40 19.6
Intern 41 20.1
Grade point average (GPA)
2.5-<3 35 17.2
3-<4 90 44.1
4-5 79 38.7

Table 2:- The perspective of undergraduate medical students regarding radiology teaching during and after the
COVID-19 pandemic.
During the pandemic After the pandemic p-value*
How do you rate the quality of on-site
radiology teaching?
Very bad 13 (6.4) 7 (3.4)
Bad 17 (8.3) 8 (3.9)
Moderate 88 (43.1) 74 (36.3)
Good 70 (34.3) 84 (41.2)
Very good 16 (7.8) 31 (15.2) <0.001
How do you rate your performance in on-site
radiology?
Very bad 9 (4.4) 7 (3.4)
Bad 14 (6.9) 17 (8.3)
Moderate 98 (48.0) 82 (40.2)
Good 66 (32.4) 61 (29.9)
Very good 17 (8.3) 37 (18.1) 0.007
How do you rate the structure of
radiologyteaching?
Very bad 5 (2.5) 6 (2.9)
Bad 12 (5.9) 11 (5.4)
Moderate 93 (45.5) 81 (39.7)
Good 72 (35.3) 74 (36.3)
Very good 22 (10.8) 32 (15.7) 0.058
Have you experienced e-learning teaching?
No
Yes 35 (17.2) 29 (14.2)
169 (82.8) 175 (85.8) 0.286

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What were your thoughts related to

radiologyteaching via e-learning?
Not important 4 (2.0) 11 (5.4)
Of little importance 21 (10.3) 18 (8.8)
Moderate 88 (43.1) 77 (37.7)
Important 63 (30.9) 71 (34.8)
Very important 28 (13.7) 27 (13.2) 0.023
How do you rate the assessment system of
radiology teaching?
Inefficient 10 (4.9) 12 (5.9)
Of little efficiency 14 (6.9) 14 (6.9)
Moderate 93 (45.5) 101 (49.5)
Efficient 63 (30.9) 58 (28.4)
Very efficient 24 (11.8) 19 (9.3) 0.067
*McNemar test

Table 3:- The perspective of undergraduate medical students regarding radiology teaching after the COVID-19
pandemic according to their gender.
Males Females p-value*
N=102 N=102
N (%) N (%)
How do you rate the quality of on-site radiology
teaching?
Very bad 4 (3.9) 3 (2.9)
Bad 5 (4.9) 3 (2.9)
Moderate 31 (30.4) 43 (42.3)
Good 45 (44.1) 39 (38.2)
Very good 17 (16.7) 14 (13.7) 0.508
How do you rate your performance in on-site radiology
teaching?
Very bad 4 (3.9) 3 (2.9)
Bad 7 (6.9) 10 (9.8)
Moderate 39 (38.2) 43 (42.2)
Good 39 (38.2) 22 (21.6)
Very good 13 (12.8) 24 (23.5) 0.064
How do you rate the structure of radiologyteaching?
Very bad
Bad 1 (1.0) 5 (4.9)
Moderate 5 (4.9) 6 (5.9)
Good 43 (42.2) 38 (37.3)
Very good 38 (37.3) 36 (35.3)
15 (14.7) 17 (16.7) 0.518
Have you experienced e-learning teaching?
No 12 (11.8) 17 (16.7)
Yes 90 (88.2) 85 (83.3) 0.316
What were your thoughts related to radiologyteaching
via e-learning?
Not important 5 (4.9) 6 (5.9)
Of little importance 7 (6.9) 11 (10.8)
Moderate 39 (38.2) 38 (37.2)
Important 44 (43.1) 27 (26.5)
Very important 7 (6.9) 20 (19.6) 0.023

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How do you rate the assessment system of radiology

teaching?
Inefficient 9 (8.8) 3 (2.9)
Of little efficiency 9 (8.8) 5 (4.9)
Moderate 41 (40.2) 60 (58.8)
Efficient 37 (36.3) 21 (20.6)
Very efficient 6 (5.9) 13 (12.7) 0.005
*Ch-squared test

Table 4:- The perspective of undergraduate medical students regarding radiology teaching after the COVID-19
pandemic according to their age.
21-24 years >24 years p-value†
N=168 N=36
N (%) N (%)
How do you rate the quality of on-site radiology
teaching?
Very bad 7 (4.2) 0 (0.0)
Bad 8 (4.8) 0 (0.0)
Moderate 58 (34.5) 16 (44.4)
Good 68 (40.4) 16 (44.4)
Very good 27 (16.1) 4 (11.2) 0.329
How do you rate your performance in on-site
radiologyteaching?
Very bad 7 (4.2) 0 (0.0)
Bad 14 (8.3) 3 (8.3)
Moderate 72 (42.9) 10 (27.8)
Good 48 (28.6) 13 (36.1)
Very good 27 (16.1) 10 (27.8) 0.201
How do you rate the structure of radiologyteaching?
Very bad
Bad 6 (3.6) 0 (0.0)
Moderate 11 (6.5) 0 (0.0)
Good 65 (38.7) 16 (44.4)
Very good 64 (38.1) 10 (27.8)
22 (13.1) 10 (27.8) 0.024
Have you experienced e-learning teaching?
No 26 (15.5) 3 (8.3)
Yes 142 (84.5) 33 (91.7) 0.201*
What were your thoughts related to radiology
teaching via e-learning?
Not important 9 (5.4) 2 (5.6)
Of little importance 15 (8.9) 3 (8.3)
Moderate 70 (41.6) 7 (19.4)
Important 52 (31.0) 19 (52.8)
Very important 22 (13.1) 5 (13.9) 0.093
How do you rate the assessment system of the
radiology teaching?
Inefficient 10 (6.0) 2 (5.6)
Of little efficiency 13 (7.7) 1 (2.8)
Moderate 87 (51.8) 14 (38.9)
Efficient 44 (26.2) 14 (38.9)
Very efficient 14 (8.3) 5 (3.8) 0.316
†
Chi-squared test *Fischer Exact test

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Table 5:- The perspective of undergraduate medical students regarding radiology teaching after the COVID-19
pandemic according to their academic year.
Pre-clinical Clinical p-value*
N=85 N=119
N (%) N (%)
How do you rate the quality of on-site radiology
teaching?
Very bad 3 (3.5) 4 (3.4)
Bad 6 (7.1) 2 (1.7)
Moderate 26 (30.6) 48 (40.2)
Good 28 (32.9) 56 (47.1)
Very good 22 (25.9) 9 (7.6) 0.001
How do you rate your performance in on-site
radiology teaching?
Very bad 4 (4.7) 3 (2.5)
Bad 7 (8.2) 10 (8.4)
Moderate 29 (34.2) 53 (44.6)
Good 24 (28.2) 37 (31.1)
Very good 21 (24.7) 16 (13.4) 0.228
How do you rate the structure of the radiology
teaching?
Very bad 2 (2.4) 4 (3.4)
Bad 3 (3.5) 8 (6.7)
Moderate 34 (40.0) 47 (39.5)
Good 26 (30.6) 48 (40.3)
Very good 20 (23.5) 12 (10.1) 0.087
Have you experienced e-learning teaching?
No 16 (18.8) 13 (10.9)
Yes 69 (81.2) 106 (89.1) 0.111
What were your thoughts related to radiology via e-
learning?
Not important 3 (3.5) 8 (6.7)
Of little importance 8 (9.4) 10 (8.4)
Moderate 32 (37.6) 45 (37.8)
Important 32 (37.6) 39 (32.8)
Very important 10 (11.9) 17 (14.3) 0.814
How do you rate the assessment system of radiology
teaching?
Inefficient 4 (4.7) 8 (6.7)
Of little efficiency 9 (10.6) 5 (4.2)
Moderate 38 (44.7) 63 (52.9)
Efficient 29 (34.1) 29 (24.4)
Very efficient 5 (5.9) 14 (11.8) 0.113
*Chi-squared test

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Table 6:- The perspective of undergraduate medical students regarding radiology teaching after the COVID-19
pandemic according to their grade average point (GAP).
GPA <4 GPA ≥4 p-value*
N=125 N=79
N (%) N (%)
How do you rate the quality of on-site radiology
teaching?
Very bad 4 (3.2) 3 (3.8)
Bad 4 (3.2) 4 (5.1)
Moderate 35 (28.0) 39 (49.3)
Good 61 (48.8) 23 (29.1)
Very good 21 (16.8) 10 (12.7) 0.020
How do you rate your performance in on-site
radiology teaching?
Very bad 4 (3.2) 3 (3.8)
Bad 8 (6.4) 9 (11.4)
Moderate 48 (38.4) 34 (43.0)
Good 42 (33.6) 19 (24.1)
Very good 23 (18.4) 14 (17.7) 0.518
How do you rate the structure of the radiology
teaching?
Very bad 5 (4.0) 1 (1.3)
Bad 8 (6.4) 3 (3.8)
Moderate 39 (31.2) 42 (53.1)
Good 55 (44.0) 19 (24.1)
Very good 18 (14.4) 14 (17.7) 0.010
Have you experienced e-learning teaching?
No 21 (16.8) 8 (10.1)
Yes 104 (83.2) 71 (89.9) 0.184
What were your thoughts related to radiology via e-
learning?
Not important 9 (7.2) 2 (2.5)
Of little importance 11 (8.8) 7 (8.9)
Moderate 46 (36.8) 31 (39.2)
Important 42 (33.6) 29 (36.7)
Very important 17 (13.6) 10 (12.7) 0.699
How do you rate the assessment system of radiology
teaching?
Inefficient 5 (4.0) 7 (8.9)
Of little efficiency 9 (7.2) 5 (6.3)
Moderate 56 (44.8) 45 (57.0)
Efficient 40 (32.0) 18 (22.8)
Very efficient 15 (12.0) 4 (5.1) 0.018
*Chi-squared test

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Smartphone 27.5

Tablet 86.3

Notebook 21.1

Desktop computer 31.4

0 10 20 30 40 50 60 70 80 90 100

Figure 1:- Participants` main device for e-learning during and afterthe COVID-19 pandemic

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