Impact of COVID 19 On nursing education

Changes of education
system during COVID-19
A. DIPOMALA DEVI
1ST YEAR MSc Nursing
AIIMS, NEW DELHI

Impact
Severe impact on education as schools, colleges and universities closed their premises in response
to lockdown measures
Effect
In India, around 32 crores learners stopped to move to schools, colleges and universities
Measures
Quick to replace face-to-face lectures with online learning

Pandemic
WHO declared COVID-
19 as pandemic on Mar
11, 2020
4
India
On 24 March 2020, the
Government of India
ordered a nationwide
lockdown for 21 days
5
HISTORY OF COVID 19 PANDEMIC
1
Origin
First identified on Dec 31,
2019 in Wuhan, China
Death
61 year old man in Wuhan,
China was reported first
death case by coronavirus
on Jan 11, 2020
2
Official Name
WHO proposed official
name of the Disease as
COVID-19 and the virus
name as SARS- CoV – 2 on
Feb 11, 2020
3

EDUCATION PRIOR TO THE COVID 19
● was conventional
● physical classroom
● less technology use
● structured and planned

“WAS NOT
READY FOR
SUDDEN
CHANGES”

Action taken by Govt. of India on education
during Covid-19
Educational Institutions Shutdown
To prevent spread of pandemic COVID-19, the Government of India has taken number of
preventive measures. The union government declared a country wide lock-down of all educational
institutions on 16 March 2020
Exam Postponed
Central Board of Secondary Education postponed all examinations of secondary and higher
secondary schools on March 18, 2020 throughout India. CBSE released revised guidelines for
examination centres to conduct examinations by maintaining a distance of at least 1 meter between
the students taking the exam with a class not having more than 24 students
Online Learning
Online learning is the best solution during this pandemic Covid-19 situation. So, the digital India
vision of the government is emerging as a vital tool for solving the present crisis due to Covid-19. It
is a fact that technology-based education is more transparent with all respect

IMPACT OF COVID 19 ON EDUCATION SECTOR
• In a nation like China that practices a considerably more centralization
system, a change to digital learning may be simpler to apply
• Even in a nation like the U.S.A, there are some low pay students who don’t
approach broadband and are unable to use computerized learning
arrangement
• The same is the situation that happens with India, may be worse as India is a
developing country, where not every student is well equipped with the high-
speed internet and digital gadgets and are along these lines of suffer
• Numerous advanced educational institutions in India are not also equipped
with digital facilities right now to cope up with sudden change from traditional
education set up to the online education system

RESEARCH INPUT
COVID-19 Lockdown: How the Pandemic Bringing Change in Indian Education
System
Neeru Rathee, Chiranjit Sarkar
Method of the Study - It is an empirical research study. In this research, the
researcher used empirical evidences. It was collected through direct and
indirect observations and experienced faced during this lockdown period.
Results of Empirical articles are used in this research including charts, graphs
and statistical analysis

● Source of Data - The data was collected through primary and secondary
sources for this research. The primary data were collected through a
Structural questionnaire using Google forms from various schools and
Colleges students and faculties in West Bengal. The secondary data
was collected using books, journals and websites.
● Sample and Population - A samples comprising of 175 teachers and
students was selected using a Purposive sampling method. There are 20
colleges and 30 schools at Paschim Bardhaman in West Bengal.

Conclusion -
Due to the lockdown and closure of schools and colleges, the students are
facing lack of offline classes. The students are unable to use the laboratories, go for
internship or appear in the examinations. The students are studying only theoretical
knowledge. The impact is more severe for rural students and below poverty line
students because in rural areas there are network issues. The majority of the parents
are not having a mobile phone with an internet connection. In the rural area, they
are major disturbance with mobile connectivity. The government is launching
various schemes to provide online quality education to students

NEGATIVE IMPACT OF COVID 19
• Educational activity hampered
• Impact on employment
• Unprepared teachers/students for online education
• Reduced global employment opportunity
• Increased responsibility of parents to educate their wards
• Loss of nutrition due to school closure
• Access to digital world
• Access to global education
• Payment of Schools, Colleges fee got delayed
• Infrastructure

NEGATIVE IMPACT OF COVID 19
● New admission in the courses are delayed
● Postponing students exit exams
● Delayed in convocations
● Delayed in final graduation

POSITIVE IMPACT OF COVID 19 ON EDUCATION
• Move towards Blended Learning
• Rise in use of Learning Management Systems:
• Enhance the use of soft copy of learning material:
• Improvement in collaborative work
• Rise in online meetings
• Enhanced Digital Literacy
• Improved the use of electronic media for sharing information
• Worldwide exposure
• Better time management
• Demand for Open and Distance Learning

COVID 19 IMPACT ON NURSING AND
MEDICAL EDUCATION
• Withdrawal of students from clinics
• Digital education
• Interruption in nursing education completion
• Fear of practicing own profession
• Affect on students health

● Courses offered by WHO for health care professionals
● Webinars – national and international
● AIIMS webinars on different topics
● Training on COVID 19
● SARAL Platform by AIIMS
COVID 19 IMPACT ON NURSING AND
MEDICAL EDUCATION

Digital initiatives of MHRD for
Secondary Education
DIKSHA ePathshala NROER
The portal contains e-Learning content
for students, teachers, and parents
aligned to the curriculum, including
video lessons, worksheets, textbooks
and assessments
It is an e-Learning app by NCERT for
classes 1 to 12 in multiple languages.
The app houses books, videos, audio,
etc. aimed at students, educators and
parents in multiple languages including
Hindi, Urdu, and English
National Repository of Open
Educational Resources (NROER) is a
portal that provides a host of resources
for students and teachers in multiple
languages including books, interactive
modules and videos including a host of
STEM-based game

Digital initiatives of MHRD for
Higher Education
SWAYAM Swayam Prabha e-PG Pathshala
It is the national online education
platform hosting 1900 courses covering
both school (classes 9 to12) and higher
education (under graduate, post
graduate programs) in all subjects
including engineering, humanities and
social sciences, law and management
courses.
It has 32 DTH TV channels transmitting
educational contents on 24 x 7 basis.
These channels are available for
viewing all across the country using DD
Free Dish Set Top Box and Antenna.
The channel schedule and other details
are available in the portal
It is for postgraduate students.
Postgraduate students can access this
platform for e- books, online courses
and study materials during this
lockdown period. The importance of
this platform is that students can
access these facilities without having
internet for the whole day

E-gyankosh
● It is an platform to provide and promote
Digital study materials to the IGNOU
Students
● Easy to download, easy to save and
Easy to read

TERMINOLOGY
Asynchronous learning
A learning event in which teachers and students participate at different times. Generally, there is no
real-time interaction between the teacher and the students
Synchronous learning
A learning event in which teachers and learners engage at the same time. The place
may be same or different. It is conventionally used in the context of online learning
Distance learning
A form of remote teaching-learning method where media replaces word of mouth as the sole means
of academic communication. There is often a spatial distance between the teacher and the student
E-learning
Teaching-learning which is delivered using electronic resources. The teacher and the student may
be within the same classroom or at a remote location

TERMINOLOGY
Flipped classroom
An approach where the conventional sequence of teaching-learning activities is reversed. Students
read the material at home before the class and then use the classroom time to discuss, clarify
concepts, create and apply knowledge
Online Learning
Teaching-learning interactions which take place over the internet. This term is conventionally used
for learning that happens across a distance. Learning can happen either partially or purely through
the internet
Pedagogy
Theory and practice of education
Blended learning
Learning which integrates online learning with conventional face-to-face (f2f) teaching also called
‘hybrid learning

ONLINE LEARNING ON MEDICAL AND
NURSING FIELD
Same place, Same
time
Conventional/face
to face
Same place, Different
time
Synchronous
learning
Different place,
Different time
Asynchronous
learning
Part combinations
Blended Learning

RESEARCH INPUT
● Impact of the COVID-19 pandemic on medical education: Medical
students’ knowledge, attitudes, and practices regarding electronic
learning
● Ahmed Alsoufi et al
Methods
● They conducted a cross-sectional survey from May to June, 2020. The
survey involved a questionnaire that was distributed, in either a paper-based
or online version by means of email and social media, to more than 13
medical schools in Libya, which have over 12,000 medical students

Students enrolled in these medical schools were selected as follows. In the online version,
using Google Forms, a specific question related to medical students’ enrollment status and
the name of the school that they attended was used to ensure appropriate selection without
recording identifying data. A Google Form containing the study questionnaire was
distributed among specific social media groups comprising medical students, or personal
emails and messages were sent to them to ensure the appropriate selection of study
participants
A friendly reminder was sent to potential respondents to ensure the highest possible
response rate. The paper version was distributed among medical students through medical
schools and peers. Completed paper questionnaires were collected in a predetermined
place for each school by one of the authors to ensure confidentiality and to prevent any
response bias. Unreturned questionnaires were recorded as missing. Participants were not
aware of the study aim or outcomes to reduce the risk of any possible bias. The survey
included only medical students who were enrolled in Libyan medical schools. The
questionnaire was self-administered without intervention by the authors or any specific
person, and it did not contain any identifying data of the participants to ensure
confidentiality. Questionnaires with incomplete information or missing data were excluded
from the analysis

RESULT -
Impact of COVID-19 on medical education
Medical schools have suspended the educational process due to the COVID-19
pandemic. However, when students asked about their current enrollment status and
whether they suspended or paused their education due to any other causes, we found
that most students did not suspend their education and were enrolled officially at the
beginning of the pandemic (3,050; 91.1%), while 8.9% suspended their education for
several reasons. However, 3,251 (97.1%) participants reported suspended lectures and
educational programs due to the COVID-19 outbreak, while 2,879 (86%) reported that
their medical school had suspended clinical training and laboratory skills training. Only
162 (4.8%) participants reported that they were in training, and 274 (8.2%) had
volunteered as healthcare allied forces during COVID-19.

● Medical students’ attitudes toward COVID-19-
Majority of the students (59%) agreed to help in hospitals during the pandemic.
Moreover, majority of them (75%) felt that they were wasting their study potential due to
the pandemic and resultant school closure. 53.4% agreed that the pandemic had
affected their personal wellbeing, and 51.8% were worried about being exposed to
COVID-19 during their clinical training. However, 45.4% of the respondents reported that
COVID-19 had no impact on their career and future specialty training. 40.3% of the
students believed that their medical faculty had provided guidance for students during
the pandemic. Furthermore, the majority of the respondents (69.6%) reported that the
pandemic had affected the timeline of the training program, while many agreed that
COVID-19 had affected their physical (41.3%), social (53.4%), and mental wellbeing
(72.2%) as well as their intellectual ability to learn (53.8%).

● Assessment of medical students’ attitudes toward e-learning
Majority of the respondents (64.7%) disagreed that e-learning could be applied easily in Libya. Only
56.3% agreed that downloadable video lectures are better than live lectures. While 54.1% agreed
that interactive discussions are achievable by means of e-learning. Only 21.1% agreed that e-
learning could be used for clinical aspects, as compared with 54.8% who disagreed with this
statement and 24% who were neutral. While 49.7% of the respondents agreed that e-learning can
cover practical lessons.

● Approximately 38.2% agreed that e-learning can replace traditional teaching
methods, although 73.6% disagreed and they believed that the quality of the
local internet was not good enough to facilitate e-learning platforms. Moreover,
78.3% found it difficult to participate in e-learning due to financial costs, as
local medical education is public and free in Libya. On the other hand, 20.2%
believed that medical schools can implement e-learning throughout the
pandemic. Finally, 60.2% agreed that an electronic certificate must be
acknowledged

Online learning: What works, what doesn’t
• Several factors influence the effectiveness of online learning. These factors include
technical skills, academic skills, learner motivation, administrative issues, social
interaction, time management, technical problems, cost, and accessibility to the
internet
• If faculty in higher education are not adequately trained in educational methods, the
problem of ineffective teaching gets exaggerated during online sessions as it has
special requirements. Online teaching requires a learner centered approach, where
teachers need to be competent in using principles of pedagogy, constructive and
transformative learning, and assessment and feedback
• Online learning has been reported to be as effective as didactic teaching. It can also
be instrumental in promoting self-directed learning. Learners can have greater control
over their learning as they can go over the content at their own pace. Teachers too can
evaluate competencies through online assessments and provide learners feedback for
self-improvement

ONLINE LEARNING FORMATS
• Online learning platforms now offer many opportunities that are being widely used
around the world, such as online videos, tutorials, webcasts, video-conferences and
virtual simulations
• Classroom lectures have now been replaced by live-streamed online lectures, where
technology allows recording and online dissemination. Small group discussions and
tutorials have been replaced with interactive webinars using online platforms. Almost
all these learning resources can also be easily accessed using smartphones
• Online teaching-learning can be implemented through synchronous or asynchronous
modes. The range of available choices for real-time communication extends from
online discussion spaces to online chat rooms to online meeting applications

ONLINE LEARNING FORMATS
• Information or learning resources can be posted on online platforms, such as
websites and blogs. Videos can be shared to demonstrate essential clinical
skills, procedural skills or communication skills
• Online learning offers flexible learning experiences and allows learners the
freedom to experiment with learning at their own pace. It is however not a
replacement for f2f teaching. It is initially expensive to set up and requires
familiarity with technology
• Lectures, problem-based learning, simulated lab work, sessions using virtual
patients, and discussions can be conducted online, both in synchronous and
asynchronous mode. All of these, if used effectively, can build in student
engagement and interaction

WHO’s GUIDELINES FOR REOPENING OF
SCHOOLS, COLLEGES, UNIVERSITIES
• Ensuring continuity of safe, adequate and appropriate educational and
social learning and development of children
• Minimizing the risk of SARS-CoV-2 transmission within school and school-
associated settings among children, teachers and other school staff

States reopening schools from January 2021

COVID-19 prevention and control measures
Physical distancing at school
• Maintain a distance of at least 1 meter for both students (all age-groups) and
staff, where feasible. Inside classrooms, the following age-appropriate
measures may be considered based on local SARS-COV-2 transmission
intensity
• Community-transmission districts/sub-districts
• Cluster-transmission districts/sub-districts
• Sporadic cases transmission districts/sub-districts
• No cases transmission districts/sub-districts

Physical Distancing Between Groups
• Limit mixing of classes and of age groups for school and after-school
activities
• School districts with limited space or resources may consider alternative
class modalities to limit contacts between different classes. For example, in
the staggering modality, different classes start and end at different times
• The high-school timetable can be modified, with some students and teachers
attending in the morning, others in the afternoon, others in the evening.
Schools can also minimize shared break times by alternating when and
where classes take meals
• Ensure crowd control during school or day-care drop off and pick up periods;
clearly identify entry and exits, with marking direction for walking, consider
restrictions for parents and care-givers entering school campus and premises

Use of Masks In School Settings
• For children between six and 11 years of age, a risk-based approach should
be applied to the decision to use a mask
• Children and adolescents 12 years or older should follow the national mask
guidelines for adults
• Teacher and support staff may be required to wear masks when they cannot
guarantee at least a 1-metre distance from others or there is widespread
transmission in the area
• Children should not be denied access to education because of mask wearing
or the lack of a mask because of low resources or unavailability
• All efforts should be made to ensure the use of a mask does not interfere
with learning

VENTILATION
• Consider using natural ventilation (i.e., opening windows if possible and if it is
safe to do so) to increase dilution of indoor air by outdoor air when
environmental conditions and building requirements allow
• Ensure adequate ventilation and increase total airflow supply to occupied
spaces, if possible
• If heating, ventilation and air conditioning (HVAC) systems are used, they
should be regularly inspected, maintained and cleaned. Rigorous standards
for installation and maintenance of ventilation systems are essential to
ensure that they are effective and safe. The same applies to monitoring the
condition of filters. If feasible, increase central air filtration to the highest level
possible without significantly diminishing design airflow

VENTILATION
• Disable demand-control ventilation (DCV) controls that reduce air supply
based on temperature or occupancy
• Consider running the HVAC system at maximum outside airflow for 2 hours
before and after times when the building is occupied, in accordance with the
manufacturer’s recommendations

Hygiene and daily practices at school
• Educate everyone in the school about prevention of COVID-19, including
appropriate and frequent hand hygiene, respiratory etiquette, use of mask
use, if recommended, symptoms of COVID-19 and what to do when one feel
sick, offer regular updates as the pandemic evolves, counter rumours and
misleading information through messaging and communication
• Create a schedule for frequent hand hygiene, especially for young children,
specifically at school arrival and at certain key moments of the school
routine, including before snacks and lunch and before school exit; provide
sufficient soap and clean water or alcohol-based rub at school entrances and
throughout the school and in classrooms where feasible; ensure physical
distancing when students wait at hand hygiene/washing points using signage
on the ground

• Schedule regular cleaning of the school environment daily, including toilets,
with water and soap/detergent and disinfectant;1 clean and disinfect
frequently touched surfaces such as door handles, desks, toys, supplies,
light switches, doorframes, play equipment, teaching aids used by children
and covers of shared books; elaborate checklists for schools’ cleaners to
ensure all daily hygiene tasks are accomplished and ensure provision of
cleaning and protective supplies for cleaning staff such as personal
protective equipment (PPE)
• Assess what can be done to limit risk of exposure, or direct physical contact,
in physical education classes, sports, music or other physical activities and
playgrounds, wet areas (shower/pool) and changing rooms, labs/computer
labs, libraries, bathrooms and dining areas/cafeteria

• Increase frequency of cleaning in the canteen, gym and sports facilities and
changing rooms.
• Put in place respiratory and hand hygiene and physical distancing measures
in transportation such as school buses. If possible, the bus windows should
be kept open; provide information for students on safe commuting to and
from school, including for those using public transportation

Screening and management of sick students, teachers and other
school staff
• Enforce the policy of “staying at home if unwell” for students, teachers or
school staff with potential COVID-19 infection and connect them with local
healthcare providers for assessment, testing and care.
• Create a checklist for parents/students /staff to decide whether they can go
to school, with due consideration for the local epidemiology of COVID-19.
The checklist should include: underlying medical conditions and
vulnerabilities, to protect the student/staff; recent illness or symptoms
suggestive of COVID-19, to prevent spread toothers; Special circumstances
in the home environment, to tailor support as needed

Screening and management of sick students, teachers and other
school staff
• Ensure students who have been in contact with a COVID-19 case stay home
for 14 days. School officials should notify public health authorities in the
event of a positive COVID-19 case among students or staff
• Consider daily screening for history of fever or feeling feverish in the previous
24 hours upon entry into the building for all staff, students and visitors to
identify persons who are sick

Communication with parents, students, teachers and school staff
• Ensure frequent communications and messaging on COVID-19 and school measures
that will reassure parents, students, and teachers that schools are safe to attend once
the mitigation measures have been undertaken.
• Inform parents about the measures the school is putting in place and ask for
cooperation to report any cases of COVID-19 that occur in the household.
• Consult with students, school staff and teachers about the measures the school is
putting in place and their roles

WHAT THE FUTURE HOLDS FOR ONLINE
LEARNING IN INDIA
• As a lifelong learner, the Indian Medical Graduate is expected to “demonstrate ability
to search (including through electronic means), and critically evaluate the medical
literature and apply the information in the care of the patient”
• The new curriculum has reserved time for self-directed learning during every phase of
the MBBS course
• One of the Objectives of Foundation Course is “to enable the learner to acquire
enhanced skills in use of information technology”
• It also recommends mandatory provision of virtual lecture theatres
• The document recommends mandatory provision of skills laboratory in every medical
college
Medical Council of India recommends e-learning at the
following:

THE PEDAGOGY OF ONLINE LEARNING
• Online learning must not be restricted to delivery of information: Online methods
should not merely be used as tools to distribute teachers’ notes or PowerPoint slides
• Online tools must be explored to teach all domains: Ways and means to teach
psychomotor skills, communication skills, ethics, and medical humanities via online
mode must be explored
• Online tools must be used to innovate and create knowledge: Online teaching must
address higher-order cognitive skills. It must promote creativity, innovation, critical
thinking and problem-solving skills
• Online approaches used must encourage participation and collaboration: Online
learning must be conducted through ‘involvement’ and ‘inclusiveness’ of the learners.
This will also reduce learner isolation

THE PEDAGOGY OF ONLINE LEARNING
• Feedback, support and mentoring of learners must be carried out: Learners
in online sessions need more interactivity, mentoring, support, feedback and
evaluation than the traditional classrooms. Communication between
facilitators and learners must be encouraged
• Online teaching must be supplemented by online assessment: Periodic
formative and summative assessment must be built into online courses
• Quality assurance of online teaching and learning must be monitored: Quality
assurance in online teaching must be adopted within the institutional policy
documents

BUILDING STUDENT ENGAGEMENT ONLINE
• Allow students to do most of the work: It is important to give students time to
engage and interact with the content. Student should be taught to take up
responsibility for their own learning. This must be supplemented by
facilitating discussions amongst students, and by giving them collaborative
projects
• Interactivity is the heart and soul of effective learning: Students must be
given opportunities to interact with the content, teacher, peers, environment
and context
• Strive for presence: Teachers should strive to ensure the following three
types of presence in their online sessions: Cognitive presence; Teaching
presence; Social presence

BUILDING STUDENT ENGAGEMENT ONLINE
Type of presence Examples
Cognitive presence
(Related to content)
• Select suitable content
• Arrange from simple to complex
• Introduce content in bite-sized modules
• Introducing conceptual and theoretical knowledge into
discussions
Teaching presence
(Related to instructor)
• Facilitating discussions
• Acknowledge and encourage students’ contribution
• Identify areas of agreement and disagreement
• Respond to technical concerns
• Set the appropriate climate for learning
Social presence
(Related to interaction)
• Allow students to express emotions
• Ask for evidence of reading, thinking and understanding
others’ responses
• Build cohesiveness amongst learners by given group work
and allowing student-student interactions

GOOD ONLINE TEACHING PRACTICES
• Principle 1: Teaching-learning methods must match curricular objectives and
assessment
• Principle 2: Synchronous and asynchronous teacher-student interaction must
be encouraged
• Principle 3: Promote higher order thinking skills and communication skills
• Principle 4: Teamwork and cooperation among students must be encouraged
• Principle 5: Encourage active learning
• Principle 6: Encourage development of self-directed learning

GOOD ONLINE TEACHING PRACTICES
• Principle 7: Opportunities for online summative and formative assessment
must be provided
• Principle 8: Mechanisms for providing prompt feedback must be built into the
course
• Principle 9: Effective time management and timely task completion must be
emphasized
• Principle 10: All stakeholders must communicate high expectations from
students
• Principle 11: Respect diverse talents and ways of learning
• Principle 12: There must be a robust mechanism for monitoring development
and mentoring

TEACHER ROLES AND COMPETENCIES
REQUIRED FOR ONLINE TEACHING
Students’ expectations during online courses
• Easy to follow course design and navigation
• Clear directions for activities and assessments
• Reasonably quick grading and feedback
• Regular communication from the instructors

TEACHER ROLES AND COMPETENCIES
REQUIRED FOR ONLINE TEACHING
Teacher roles
• instructional designer
• content facilitator
• technologist
• process facilitator
Teacher Competencies
• manager or administrator
• researcher
• advisor or counsellor
• Knowledge of the online process
• Technical skills
• Online communication skills
• Content expertise
• Personal attributes: inherent
motivation, integrity, visible,
responsive and approachable

SKILLS NEEDED FOR ONLINE TEACHING
Communication
skills
Technological
skills
Design skills
Pedagogical
skills
Managerial skills
general computer
literacy to be able
to use word
processor, spread
sheets, and video
conferencing
applications
full complement
of teaching skills,
including
generating
learning
objectives,
matching content
and mode to
objectives
understanding
and applying
instructional
design principles
using learning
materials in
different formats
Ability to manage
time,
demonstrating
leadership,
managerial and
mentoring skills,
handling
assignments and
record keeping
need for clear
and concise
instruction is
important for
online teaching

TECHNOLOGY FOR ONLINE TEACHING
• Websites and blogs – access to stored information and repositories;
electronic versions of scientific papers
• Multimedia technology – appropriate combination of video / still images and
sound
• Asynchronous modes – like threaded discussions, assignments
• Interactive resources – providing real time interaction between teachers and
students
Moore’s law
Moore’s law, which is often extrapolated to state that technology advances which almost doubles
every eighteen months, suggests that training people in use of one technology will have limited
effect

Do’s and Don’ts when using technology in
online teaching
Do’s Don’ts
Choose and integrate appropriate technology that supports overall
educational goals and curricular objectives.
Avoid using technology for the sake of using it, if it doesn’t support
the lesson plan. It is a costly mistake which must be avoided.
Train and encourage teachers to make judicious use of technology
in their classrooms
The role of technology should be to empower teachers and learners
rather than to replace them
Technology should be adjustable in terms of students’ skills and
abilities, provide feedback on progress, and give them enough
opportunities to collaborate in the teaching-learning process
Instructors should not be over-dependent on technology. No
technology is foolproof, and technology depends on multiple
external factors
Ensure that teachers and learners are actively involved with a
range of relevant and practical engagement techniques. Such
strategies should become standard practice
Mere use of technology doesn’t necessarily guarantee
engagement. Student engagement strategies will need to be built in
while designing a lesson plan
An optimal level of fidelity (realism) is preferred when using
simulations. The degree to which technology simulates the intended
task or environment must preferably match with the learner’s
expertise and the educational objectives of the module
Every technology requires a minimum level of infrastructure, in
terms of hardware and software tools or internet accessibility.
Students with limited access to these technologies must also be
considered during planning. Fair and equal access to all students is
a pre-requisite for use of technology

Implementing Online Teaching
Identify session objectives for the target group of learners
Break down the lesson into bite-sized part
Decide which will be used: synchronous or asynchronous;
flipped classroom; video; online lecture; assignments with
built in learning activity
Consciously build in strategies for student engagement and
formative assessment
Plan to give feedback on assessment. Build in ways to gather
feedback during and after the session

CONDUCTING ONLINE SESSIONS
• Try and learn learners’ names and use them
• Build a rapport with learners: use formal and informal ways of interaction,
model disclosure
• Create the right environment for the class; build trust
• Be available to answer questions and solve doubts
• Introduce interactivity through online tools which enable conduct of polls, and
gather real-time response
• Embed multiple choice questions or quizzes between the session to gauge
learning understanding

CONDUCTING ONLINE SESSIONS
• Ask how and why questions to challenge learners like you would be in a
traditional classroom
• Give opportunities for learners to ask questions and clarify their doubts
• Check if the pace of the lesson is fine with the class
• Use break-out rooms and give group work
• Encourage discussions online

Online classroom management
Conventional class
In a conventional classroom, the teacher can ‘see’ all
students, notice their body language, ask/answer
questions from specific students and move around in
the class.
Online Class
In online classes, generally students remain
‘anonymous’, especially when the online class
size is large. This usually helps otherwise shy
students to ask doubts using the chat box
function. While mobile devices are generally
discouraged in conventional classes, they play an
important role in online classes.

POST-SESSION ASSESSMENT AND
EVALUATION
• Wherever possible, plan to conduct online summative assessment after an
online teaching session
• Some simple informal classroom assessment techniques such as polls,
muddiest point or one-minute paper can help in knowing whether the
concepts just taught have been understood by students or not
• Evaluation must be carried out as part of quality assurance practices
• Student feedback can help in improving the manner of delivery of this
content. More on this topic can be read in the section on Quality Assurance
of online learning

TEACHING PROCEDURAL SKILLS ONLINE
• Cognition or understanding the task: This needs explanations about the activity
• Automation or ability to perform a task with efficiency, speed and precision: This
needs little cognitive input but automated performance. The focus is on refining
performance
• Integration or comprehension and performing the mechanics of the task: This
needs provision of feedback and deliberate practice
Fitts and Posner’s three-stage theory of motor skill acquisition is
a popular method used in teaching surgical and motor skills.

TEACHING PROCEDURAL SKILLS ONLINE
• Step 1: Demonstrate: The instructor shows the skill at a normal pace. No additional
comments are offered at this step
• Step 3: Trainee talks trainer through: Here the trainee describes the steps while the
instructor performs the skill for the third time, based on the trainee’s description
• Step 2: Talk the trainee through: The instructor describes each sub-step of the
procedure while showing the skill again to the students
Peyton suggested a four-step approach to introduce skills to new
trainees as follows:
• Step 4: Trainee does: The trainee performs the skill on his or her own

ONLINE ASSESSMENT
• Assessment before teaching: Using short quizzes or tests before starting a topic can
be useful for teachers to gauge the baseline knowledge and skills of the students
• Assessment during teaching: This can be done at the level of a course or at the
level of a teaching session
• Assessment after teaching: This can be done at the level of a unit or at the level of a
course
• Assessment as learning: It is customary to classify assessment as formative
(assessment for learning) and summative. The contemporary trend is to use
assessment to facilitate learning. This involves giving students an assessment task
which will require them to go through an authentic experience or perform an activity,
and thereafter submit a report

FORMATS FOR E-ASSESSMENT
• Multiple choice questions and its variants
• Short answer questions
• Online polls
• Picture based questions based on audio-visual clues
• Electronic Patient Management Problems
• Objective structured video examination (OSVE)/ OSCE
• Projects
• Portfolios

Assessment in clinical settings
• When it comes to assessing clinical competencies, cognitive parts of
competencies such as clinical reasoning and communication skills can be
assessed online
• Simple electronic patient management problems or complex AI technology-
based virtual patients (computer-based simulations) can be used to test
clinical reasoning skills
• There have been reports where Objective Structured Video Examinations
(OSVE) have been used with some evidence of being valid. In an OSVE,
different clinical scenarios were chosen depending upon the clinical and
communication skill competencies to be tested

Assessment in clinical settings
• Short patient-clinician interactions, less than 10 minutes long, were scripted
and filmed. Each scenario included some deliberate communication skills
elements such as greeting the patient, checking for the identity, use of open
and closed questions, eye contact, displaying empathy, clearing doubts,
summarizing and closing
• Now, with the availability of software which permits real time interactivity
such as Google Meet, Zoom or Skype, students can be observed and
assessed on history taking or communication skills using real or standardized
patients
• With the availability of break-out rooms, several institutes are experimenting
with conduct of online or electronic OSCEs. This, however, requires a great
deal of coordination and planning so that students move in and out of online
OSCE sessions seamlessly

Experiences shared by students regarding
online class by AIIMS students
• No interaction between teachers and students
• Lack of concentration
• Physical illness like headache, eye strain, earache
• Poor internet connection, background noise
• No break between classes
• Not learning practical skills
• Limited learning

Solving the online classroom fatigue
• Shifting places where internet connectivity is good
• Do meditation when feel tired
• Join with my friends during the online class
• Light background presentation and font size should be adequate for better reading
• Discussing with batchmates after online class to remember the topics explained
• Sit on chair and keep the device at normal distance so it doesn’t gives eye strain

CONCLUSION
COVID-19 is an ongoing crisis; it is a real-time lesson in equity, leadership,
social justice, ethics, and patient care. The world is facing unprecedented
challenges in the face of a global pandemic. Coronavirus disease 2019
(COVID-19) has, to date, killed thousands worldwide . The data related to
numbers of tests administered, positive cases, hospitalizations, and deaths,
changes on an hourly basis. Mounting concerns regarding the strain on health
care systems globally are already occurring and likely to get significantly worse.
This health crisis impacts not only frontline staff and clinical leaders but all
systems and communities. COVID-19 has also already disrupted universities
and academic institutions. Within the health field, schools of nursing are bracing
for unique challenges related to our role in helping develop the next generation
of care providers.

“Blended learning is
the future”
*************************************************

Impact of COVID 19 On nursing education

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