key: cord-347504-pkkh9uy4
authors: Rajhans, Vidyut; Memon, Usman; Patil, Vidula; Goyal, Aditya
title: Impact of COVID-19 on academic activities and way forward in Indian Optometry
date: 2020-06-13
journal: J Optom
DOI: 10.1016/j.optom.2020.06.002
sha: 
doc_id: 347504
cord_uid: pkkh9uy4

Abstract Purpose Academia is experiencing massive reforms globally amid lockdown in COVID-19 outbreak. This study is aimed to apprehend the enabling and impeding factors of these reforms, with a focus on optometry education. It brings together how the Indian optometry educational system has responded to COVID-19 disruptions with findings of the 2020 survey, in light of similar survey done in 2018. Methodology A cross-sectional survey was designed to find changes in optometry training and adaptations of Indian optometry educators amid COVID 19 lockdown. In the last week of April 2020, on the observation that the majority of optometry institutions have switched their teaching-learning activities on e-learning mode, an online survey was conducted using a validated questionnaire containing a mix of open and close-ended questions. Results Seventy-three out of 78 optometry educators (93.58%) have switched to e-learning mode in a very short time span with good confidence. Most teaching-learning and assessment activities are carried out using multi-device supporting video conferencing tools, dedicated educational portals and social media apps. Conclusion The COVID-19 pandemic is proving to be constructive disruptor, giving an opportunity for restructuring the present conventional, classroom based educational system. The quick transitions to online mode assisted in keeping continuity of optometry education programs, effectively fitting in the purpose of completion of the current academic year. The rapid transition to online education has not only benefited optometry students but also has created a momentum of continued education for practicing optometrist in the country.

As of 10 May 2020, COVID-19 pandemic has gripped 215 countries across the globe and many of these faced lockdown 1 . Academia was among the first few sectors that faced rapid shut down of all its activities 2 . Thousands of schools and higher education institutions and millions of students are affected by lockdown due to the COVID-19 pandemic as the first response from the educational sector was to completely halt its operations 3 . Coronavirus pandemic has triggered the significant change, imposing many challenges in the higher education community globally 4 . After about four months in the global crisis, we have started realizing that the COVID-19 is here to stay and we need to find solutions to move on. This crisis can be looked upon as an opportunity to reconstruct our longstanding educational systems and establish better and updated practices in academia, suitable for the present generation of learners 5 . We must prepare ourselves for the changing world when COVID-19 pandemic is blown off.

India is a demographically diverse large country with high population density. The nationwide lockdown was the only strategy in the fight against COVID-19 pandemic, which started on 25 th March 2020 and is continued in its fifth phase until 30th June 2020 with some relaxations in no infection areas 6 . Citizens across the country chose to sit in their homes abiding the guidelines issued by the government of India.

Academic activities in India were rapidly halted in the middle of the year, by individual institutions and states even before the countrywide lockdown began 7 . As per the recent guidelines issued by University Grant Commission (UGC), the apex body for higher education in India, the educational institutes must strive to provide quality education, ensuring uniformity, equity and universal accessibility to all the learners 8 . There is constant encouragement from Hon. Prime Minister Shri Narendra Modi, for innovative use and promotion of technology in ushering educational reforms to create a vibrant knowledge society 9 .

Medical and healthcare education is also severely affected by this global crisis. Moreover, it will continue to remain affected as healthcare systems as most teaching hospitals are completely occupied by COVID-19 load 10 . The challenge of clinical exposure to the medical and health profession students will aggravate even further 11 . Owing to the rapid transmission of COVID-19, face-to-face and small group tutorials are prohibited. This imposes greater challenge especially in the context of ophthalmic and optometric skills, which requires close contact between the eye care practitioner and the patient 12, 13 . Social distancing and telemedicine are set to be 'a new normal' hereafter, imposing a persistent challenge for global optometry educators, to teach various clinical skills to the students 14 . The scenario is prompting an urgent need for transformation of optometry education, from traditional brick mortar system to e-learning environment, imparting updated competencies in our graduating optometry professionals.

Optometry educators in India have responded very quickly to this crisis situation, in the light of guidelines issued by the Government of India and UGC. There is a sudden surge seen in the number of webinars and online learning sessions on social media platforms, on various topics of optometry, attended not only by students but also by a massive number of practitioners. This has generated never before momentum in optometry education and also in continuing education programs. The purpose of this study is to apprehend the enabling and impeding factors behind this momentum. This paper reports the findings of the observational study describing the rapid transition of optometry education in India amid COVID 19 disruptions. Findings of nationwide online survey ascertaining the present practices of teaching-learning in optometry are discussed in light of similar survey done in 2018 by the same authors (VR and UM). It not only informs the readers about what changed in reference to the past but also appraises how and why the quick adaptation was possible, along with the challenges that are faced during the transition from educator's perspectives.

Study design: A cross-sectional survey was designed to find changes in optometry training and adaptations of Indian optometry educators amid COVID 19 lockdown. Questionnaire development: A cross-sectional survey was conducted in 2018 using a questionnaire comprised of 27 items (hereafter referred to as '2018 survey'). It was designed to know various teachinglearning methods used for subjects related to applied optics curriculum in optometry programs in India.

This questionnaire collected factual data about teaching learning methods used in visual optics, optometric optics and dispensing optics curriculum. The survey also gave insights on teacher's perception about academic practices followed at that time. A follow-up survey was now necessary as significant modifications are witnessed in educational activities amidst this lockdown period. Due to the drastic changeover of the situation, and to address the questions of the present study, we extensively revised the 

The 2020 survey recorded a total of 79 respondents, with 78 valid responses. One respondent was not an educator hence was omitted before analysis. Of 78 valid responses, 37 were males (47.43%) and 40 were females (51.28%). One respondent preferred not to disclose the gender identity. The survey reported representation pan India which was found consistent with the findings of the 2018 survey (Table2). The responses were received from educators in all categories of optometry institutions of India. These demographic results add value to the reliability of the present study. 

The decision of switching to the online mode of teaching was taken after consultation with students by 62 educators (84.93%) while 11 educators (15.06%) did not get a chance to consult students as the transition was very rapid. Student's training for using online platforms for learning was facilitated by 38 educators Overall perception about e-learning environment:

Overall satisfaction of educators on switching to online mode was 3.44 on the Likert scale of 1 (least satisfied) to 5 (most satisfied), indicating that most of the educators are satisfied with it. Positive perception is seen on being collaborative in adapting with this new normal, summarized in table 3 below. The 2020 survey questionnaire also asked six open ended questions to the educators, based on their experiences, to narrate the facilitating and limiting factors in transiting to online education, which are analyzed using qualitative thematic analysis methods. These findings are deliberated in the discussion section.

The table below relates the parallel findings from both the surveys, which will help us know the exact nature of the transition of the optometry education system in India. As the two surveys were done with different intentions and instruments, we do not intent to calculate statistical significance but the mere comparison will help us derive appropriate explanation for the research question under consideration. Conduct of examination Theory written examination; practical skills demonstration

Online examination for theory in the form of assignments /presentations. Skills examination in the form of roleplays and oral examination.

This study brings together how the Indian optometry educational system has responded to COVID-19 disruptions using findings of the 2020 survey, in light of findings of the 2018 survey 16 , combined with authors' experiences and observations in academia.

COVID-19 pandemic is proving to be a creative disruption with tough challenges for all educational systems 18 . At the same time, there is a strong opportunity for us to adopt newer techniques that are more suitable for the present generation of learners 19 . Lockdown is still continued in several states in India.

While some other states are starting up with gradual and prioritized restoration of their activities. With norms of social distancing in place, and the guidelines issued by UGC, the academia is likely to continue with e-learning platform at least for few more months 20 These factors kept the motivation of teachers high in adapting to e-education mode.

6. Tech-savvy iGeneration students: The present generation of learners has grown up with technology.

Greater use of online learning activities facilitate greater engagement of the learner. Ability to learn and revise at one's own pace, being independent of place and time leads to better educational prospects 27 . The forced transition to online mode is in-fact a sure GO for iGeneration learners. The students are more concerned about their education and completion of training on time 18 . In this situation of uncertainty, the students are welcoming every single act which will ensure continuity of their academic activities. They are actively involved in, not merely attending the online sessions but are also actively searching and bringing the relevant online content to the session. 7. Safe learning environment: Students are allowed to ask their doubts using social or personal messaging apps that get addressed without disclosing their identity during the online class. This type of multi-channel communication between the students and teachers is helping to achieve better outcomes 27 .

8. Ease and comfort of attending online sessions from home without physically travelling anywhere save a lot of time and energy. Further, students can choose and attend many online sessions other than regular online classes, either live or in deferred time, organized by various national and regional associations in optometry. They get to hear and interact with many faculties, the practitioners of national and international repute, which excites them to learn more.

J o u r n a l P r e -p r o o f 9. Institutional infrastructure: The use of technology, blended learning and E-learning is on the rise since about a decade 28 . These are promising techniques to foster self-learning attitude in health professional students. An increasing number of institutions are encouraging the use of technology in day to day teaching as students find it enjoyable. Purposeful and effective use of blended learning is absolutely necessary for managing student-centric learning system 28 percentage of patients requiring critical care, higher recovery rate and lesser morbidity rate 30 . This has brought a general sense of confidence which is helping in overcoming the challenges 31 . A positive and hopeful environment definitely has contributed directly or indirectly towards the success of this transformation. This is evident by the fact that our 2020 survey recorded more inputs to advantages and facilitating factors and listed out very few challenges faced during the transition to e-learning.

According to WHO, COVID-19 is here to stay for long period. The health care practices are experiencing significant changes, establishing 'new normal' by using technology of next generation. The restrictions of physical contact with patients, reduction in face to face consultation, social distancing norms are some of the challenges identified in clinical skills training 12 . These challenges will persist for a longer period of time as telemedicine, artificial intelligence and innovative technologies are ready to set in permanently into eye care systems 32, 33 . Experiential learning with direct patient exposure in already strained resources is now significantly challenged in optometry skill training. Therefore, we must find an effective longlasting solution by incorporating blended learning in educational system. A good mix of online and face to face learning is suggested while addressing the challenges surfaced during this initial experience. The respondents of 2020 survey enlisted the challenges of execution of online teaching such as uninterrupted internet connectivity, technical disturbances in apps, student orientation, adjusting the pace to suit most learners, restriction on a number of online sessions per day, extension of working hours and working on weekends. Few challenges related to communication, for example, no eye contact, face reading or body language reading to understand if students are following were also reported. The time and efforts required in the preparation of high quality customized, attractive and user-friendly educational material, suitable J o u r n a l P r e -p r o o f for digital delivery of optometry content was enormous. Institutional support in terms of faculty development, student's training for efficient use the technology was also lacking.

Students of present generation are used to group learning and value peer opinion 23 . Optometry students in India are young, having just completed schooling, without much experience. Most of them do not get in a job while pursuing their education and are financially and emotionally dependent on family, assuming very little self-responsibility. Therefore, educators do not believe that the learners will engage themselves in self-directed learning. Further, the lockdown has imposed the challenges of solo learning on them.

Hence, the total and long term transition to e-learning is challenged.

The development of dedicated online modules specific to defined areas of competency along with detailed planning of blended learning activities is required. Accessing telehealth interactions in compliment with e-learning modules can address the perceived gap in clinical skill teaching. We must move ahead from just taking online lectures to the development of more engaging and novel teaching-learning methods based on principles of adult learning 34 . We must utilize this once in a lifetime opportunity where massive sudden transitions are taking place in all sectors of life. This accelerated change if continued in the direction of upcoming trends of optometry practice will fetch positive rewards in years to come.

The 2018 study was focused more on optics related subjects while the 2020 survey addresses the entire curriculum taught by optometry faculties. In India, the optometry faculties are mostly engaged in teaching applied optics, contact lenses, binocular vision and low vision subjects 35 . Since the two surveys were addressing similar but not exactly the same research question, in different learning environments, with two different instruments, no direct statistical comparison was possible. But we felt that it was reasonable to see the results of the latest survey in the light of earlier one, in order to gain clarity about the journey so far from the traditional classroom system to the technology-aided competency-based educational system.

The COVID-19 pandemic and its disruptions have created an opportunity for the restructuring of the optometry educational system. The quick transitions to online mode assisted in keeping continuity of optometry education programs, effectively fitting in the purpose of completion of the current academic

year. Clearly, the journey from the tea steeping model of education to a competency-based learning program has commenced. Online teaching, use of internet technology in optometry education are set to become a new normal. The transition can be quick and smooth if educators and technical staff show an adaptive and collaborative attitude. It is, however, very early to conclude the successful narrative of transition as the judgment of students' performance and quality of passing out professionals is yet to be realized. Further studies may be directed to test student's performance and satisfaction on switching to the e-learning educational system.

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