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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 30  |  Issue : 5  |  Page : 567-572

Experience and perception of virtual clinical conferencing during COVID-19 pandemic by doctors at the university of Nigeria Teaching Hospital Enugu, Nigeria


1 Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria Ituku-Ozalla, Nigeria/ Postgraduate Studies Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
2 Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
3 Department of Surgery, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
4 Department of Obstetrics and Gynaecology College of Medicine, University of Nigeria Enugu Campus/ University of Nigeria Teaching Hospital Ituku-Ozalla, Ituku-Ozalla, Enugu State, Nigeria
5 Department of Medicine, University of Nigeria Teaching Hospital Ituku-Ozalla Enugu/ College of Medicine University of Nigeria Enugu Campus, Ituku-Ozalla, Enugu State, Nigeria

Date of Submission19-Jul-2021
Date of Decision02-Aug-2021
Date of Acceptance11-Aug-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Dr. Johnpaul Ejikeme Nnagbo
Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_125_21

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  Abstract 


Background: The first wave of the COVID-19 outbreak resulted in the restriction of physical meetings/gatherings worldwide as part of disease preventive measures. This restriction affected formal teaching and learning globally, including medical residency training programs in Nigeria. To sustain educational meetings during the COVID-19 disease outbreak, the Postgraduate Studies unit of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria, directed all clinical departments of the hospital to switch from physical meetings to virtual video conferencing (VVC). Aim: To determine the experience and perception of VVC during COVID-19 by resident doctors and their consultants in UNTH Enugu, Nigeria. Materials and Methods: Questionnaires were administered to 220 consenting medical doctors randomly selected from the population of resident doctors (trainees) and Consultants (trainers) at the UNTH, Enugu, Nigeria. The data were collected by an online generated Google form (self-administered questionnaire), some of which were printed and self-administered. Data analysis was done with SPSS version 20.0. Results: Out of 220 participants, 202 participants filled the questionnaires appropriately and were analyzed. Of the participants, 196 (97.0%) participated in VVC since COVID-19. Only 107 (54.6%) agreed they were satisfied while 89 (45.4%) were not satisfied. Only 108 (55.1%) respondents agreed that they preferred virtual meetings over physical meetings. A majority of respondents (79.1%, 155/196) preferred physical meetings over virtual meetings. The most common reason for preferring VVC over the physical meeting is its convenience, whereas in the converse, the commonest reason is its ability to cover all the academic programs. Conclusion: There is an improved participation level in academic residency programs by residents and consultants since the introduction of VVC, during the COVID-19 pandemic at UNTH Enugu.

Keywords: COVID-19 pandemic, experience, perception, residency programme


How to cite this article:
Dim CC, Nnagbo JE, Nwosu EO, Ugwu EO, Onodugo OD. Experience and perception of virtual clinical conferencing during COVID-19 pandemic by doctors at the university of Nigeria Teaching Hospital Enugu, Nigeria. Niger J Med 2021;30:567-72

How to cite this URL:
Dim CC, Nnagbo JE, Nwosu EO, Ugwu EO, Onodugo OD. Experience and perception of virtual clinical conferencing during COVID-19 pandemic by doctors at the university of Nigeria Teaching Hospital Enugu, Nigeria. Niger J Med [serial online] 2021 [cited 2021 Dec 8];30:567-72. Available from: http://www.njmonline.org/text.asp?2021/30/5/567/327951




  Introduction Top


Since COVID-19 was formally announced as a public health emergency of international concern and pandemic by the World Health Organization (WHO) on January 30, 2020 and March 11, 2020, respectively, global human activities have been affected in various ways.[1],[2] As of August 18, 2020, there were over 21 million confirmed cases and close to a million deaths globally, while Nigeria had 49,485 confirmed cases and 977 deaths.[3],[4] The second wave of the disease was declared in Nigeria in mid-December 2020; as of March 20, 2021, 161,539 confirmed COVID-19 cases and 2027 mortalities had been documented from the country.[5] Nevertheless, the true prevalence of the disease in the country is believed to be far higher than this, as supported by a recent survey report from Anambra State, Nigeria, which showed a SARS-CoV-2 seroprevalence of 16%.[6]

Consequent to the COVID-19 first wave, the global economic activities, businesses, trades, conferences, conventions and meetings were restricted or canceled to maintain social distancing and curtail the spread of coronavirus infection.[7],[8] This stems from the Centers for Disease Control (CDC) recommendation on the temporary halt on international travels as part of global efforts to limit the spread of COVID-19 infection from country to country.[8] Furthermore, postponement or cancellation of physical meetings whose outcome could be achieved by virtual video conferencing (VVC) was recommended to minimize the disease's spread.[9]

In line with the above recommendation, there was a global shift from holding physical meetings to virtual online meetings starting from the developed nations of the USA, UK, China, Japan, and Australia.[10] Virtual meetings involve many people worldwide regardless of their location, using video, audio, and text to link online via video teleconferencing software such as Microsoft Skype, Adobe Connect, Google's Hangout/Meet or Zoom, etc.[11] It brings a platform that enables information, data, teaching, lectures, demonstrations, and sharing of ideas in real-time without physically being together.

The impact of virtual online courses on higher education is being reviewed in some countries. According to times higher education survey that involved well over 100 institutions from the top one thousand universities, respondents from six continents were skeptical that digital/online learning would soon supplant face-to-face learning.[12] In the same survey, 63% of the participants believed that established and high-ranking universities would be offering their degrees online by 2030, while 24% believed that online courses would be more favored by 2030 and that lectures would have been replaced by information communication technology by 2030.[12] The recent popularity of virtual online meetings occasioned by the COVID-19 pandemic is not just becoming a new normal; it underscores its usefulness in maintaining social distancing even in future outbreaks. Furthermore, it has been reported that virtual rather than physical meeting saves time, cost, and improves productivity.[13] Another important virtual meeting feature is that participants can record the entire conference session for future references; this is particularly useful to students who are involved in online meetings.

Globally, in the tertiary hospitals, the residency training program was significantly influenced by the COVID-19 infection.[14] This has made the resident doctors' educational training drift towards online platforms to avoid large gatherings as recommended by the WHO.[14],[15] In a survey involving 1102 general surgery resident trainees in the USA, 80% reported a transition to online platforms for their didactic training.[16] However, they were worried over poor hands-on training sessions as residents had more time off the hospital.[16] There was also a report of high burnout rates due to concern about contracting the infection.[1] Sequel to the report of COVID-19 first wave in Nigeria and in response to the Africa CDC guideline, the Federal government, via its presidential task force, issued lockdown orders, social distancing, and travel restrictions to reduce the spread of the disease.[4],[9] These restrictions did not only affect the general livelihood of close to 200 million Nigerians; it also impacted the educational system of which the Postgraduate Medical residency training program is a component.

The residency training program is the formal professional postgraduate training for Medical doctors who wish to acquire fellowship and occupy a consultant's position in hospitals.[17] It is a time-bound structured program in which a trainee attaches him/herself to an accredited training center where didactic lectures, clinical demonstrations/simulations, hands-on management of medical and surgical cases, and surgical skills are taught.

In line with the global effort to control the COVID-19 pandemic, the Postgraduate Studies unit of the University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla directed all clinical departments to replace training-related physical meetings/conferences with the virtual learning equivalent to sustain academic programs while maintaining social distancing.[16] Observational evidence has shown that since the introduction of virtual learning in residency training in Nigeria, several online activities have been held, including Update courses by the National Postgraduate Medical College of Nigeria (NPMCN) and West African College of Surgeons and Physicians.[18],[19],[20] However, the experience, perception, benefits, and disadvantages of using virtual video meetings/conferences among resident trainees and their trainers (consultants) remain speculative. This study determined the experience and perception of VVC by medical doctors at UNTH Ituku/Ozalla, Enugu state Nigeria.


  Materials and Methods Top


The study was a cross-sectional questionnaire-based descriptive study of consenting resident doctors and medical consultants at the UNTH Ituku-Ozalla, Enugu State, Nigeria.

The UNTH is the largest teaching hospital in Southeastern Nigeria. It serves as the apex referral center for Enugu State and its environs. It is a high-capacity hospital with over 500-bed spaces, about 160 medical consultants, and 359 resident doctors in various specialties.

The UNTH is one of the foremost postgraduate residency training centers in Nigeria. It provides residency training program in thirteen specialties, including internal medicine, Surgery, Paediatrics, Obstetrics and Gynaecology, Microbiology, Morbid anatomy, Family medicine, Community medicine, Oral/maxillofacial, Radiology, Otorhinolaryngology/ Ear, nose and throat Chemical Pathology, and Ophthalmology. The UNTH management appoints the director of postgraduate studies responsible for coordinating the hospital's residency training programs in line with the guidelines of the [National Postgraduate Medical College of Nigeria (NPMCN), West African College of Surgeons (WACS) and West African College of Physicians (WACP)].

Resident doctors are eligible medical officers appointed into an accredited medical specialty training post by the hospital's management for a tenured postgraduate training by medical consultants in line with the curriculum of any of the Postgraduate Colleges (NPMCN, WACS, or WACP). The medical consultants are medical doctors who had certified specialist training acceptable to the Medical and Dental Council of Nigeria in any area of medicine and have been appointed by the hospitals as a consultant. They are responsible for offering specialist medical services, medical research, and teaching of medical students, interns, and resident doctors.

The sample size of 220 was calculated using a formula for determining the prevalence of a qualitative variable:[21] with a non-response rate of 10%.

Where n0 = sample size for infinite population, N = numbers in the known population.

The 220 respondents were selected from 519 eligible medical doctors (residents and consultants) in the hospital. The resident doctors' list, categorized by their departments, was obtained from the hospital's Postgraduate Studies unit. Similarly, the consultants' list was obtained from the administrative department of the UNTH. These lists served as the sampling frames from where the respondents were randomly selected (simple random sample). Resident doctors and consultants employed during the COVID-19 era were excluded because they had not experienced physical clinical conferences in the hospital.

Respondents completed an online pretested electronic questionnaire via a Google form link sent to their E-mail addresses. However, 30 respondents who were unable to fill the online questionnaire filled theirs manually on printed copies of the questionnaires. The online form was set to reject double entries by respondents. The questionnaire comprised of three sections; section one contained the basic characteristics of the participants such as age, sex, department, years in residency and cader, section two had questions that determined the participants' experience with virtual video meetings during the COVID-19 pandemic, while section three contained questions that assessed the respondent's satisfaction with the virtual video meetings attended during the COVID-19 outbreak. The questionnaire was pretested with 22 doctors (15 residents and seven consultants) in the OBGYN department of UNTH.

The questionnaire administration, which lasted for three months, started on September 21, 2020, after ethical approval by the health research ethics committee of the UNTH.

The information obtained was entered and analyzed using IBM Statistical Package for Social Sciences software, version 20.0. The analysis was mainly descriptive. The categorical variables such as sex, age, department, and cadre were analyzed and presented in percentages and frequencies. The level of satisfaction and other variables was determined using a 5-point Likert scale of 1–5 (interval scale), where 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree. The mean score was obtained for each variable. The scores lower than the mean were regarded as “disagree” while those at or above the mean were regarded as “agree.” Then, the proportion of participants in each category were calculated. The percentages and frequencies of various responses were obtained and documented. Results were presented in tables and charts.


  Results Top


Out of the 220 respondents, 202 (91.8%) completed the questionnaire correctly, and their data were analyzed, giving a non-response rate of 8.2%. The mean age of respondents was 39.8 ± 7.91 (range: 26–66) years. The modal age group was 30–34 years (24.8%, 50/202), while the 65–69 year age group contributed the least number of respondents (1%, 2/202). A majority (75.2%, 152/202) of respondents were male. The cader of respondents was as follows: Junior resident doctors (registrars) (39.6%, 80/202), Senior resident doctors (Senior registrars) (32.2%, 65/202), and the consultants (28.2%, 57/202). The respondents' basic characteristics are shown in [Table 1].
Table 1: Sociodemographic characteristics of participants

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Overall, 196 (97.0%) respondents had participated in their departmental/specialty's academic VVC since the COVID-19 pandemic. This proportion included, 78 (39.8%) registrars, 63 (32.1%) senior registrars, and 55 (28.1%) consultants. As regards satisfaction with VVC, only 107 (54.6%) were satisfied while 89 (45.4%) were not satisfied.

Only 108 (55.1%) respondents agreed that they preferred virtual meetings over physical meetings; their reasons included its convenience, more consultant participation, and easy access from any location. On the other hand, a majority of respondents (79.1%, 155/196) preferred physical meetings over virtual meetings and their reasons included its ability to cover all aspects of residency training, enables interaction, and normal way of learning. The details of respondents' preferences and reasons are shown in [Table 2] and [Table 3] and [Figure 1] and [Figure 2] respectively.
Table 2: Proportion of doctors and departments that use video/virtual conferencing for departmental academic programs in University of Nigeria Teaching Hospital

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Table 3: Perceptions of virtual video conferencing by doctors at University of Nigeria Teaching Hospital

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Figure 1: Participants' reasons for preferring virtual video conferencing over physical meeting for academic residency programmes

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Figure 2: Participants' reasons for preferring physical meeting over virtual video conferencing for academic residency programme

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The reported impediments to successful VVC for academic residency program include poor Internet connectivity, limitation of interaction/discussion, and limitation of monitoring of lateness/attendance which accounted for 191 (97.4%), 101 (51.5%), and 2 (1.1%), respectively. This is shown in [Figure 3] below.
Figure 3: Impediments to the use of virtual meeting for academic programs since COVID-19 in University of Nigeria Teaching Hospital

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  Discussion Top


The high level of participation of resident doctors and their trainers (consultants) in VVC for academic residency programs since the Nigerian Center for Disease Control began to implement its COVID-19 preventive protocols in Nigeria is remarkable. A similar high level of participation was reported in the USA where cardiology and general surgery residents resorted to online sources for their academic programs at the inception of the COVID-19 outbreak.[14],[16] Though the reason for the high rate of participation as recorded in this study may not be clear, it may not be unconnected with the fact that the training is time-bound and trainees must complete their curriculum prior to graduation irrespective of the COVID-19 outbreak.[14]

The proportion of participants who agreed that VVC is preferred over the physical meeting is considered high when compared to the proportion who disagreed. This corroborates the significant proportion (79.1%) who agreed that physical meeting is preferred over VVC for academic residency training.

This finding is not surprising because VVC is known to limit interactions, affections, and emotions.[22] Part of the reasons participants preferred physical meetings over VVC may be as a result of the fact that some aspects of the residency programs such as objectively structured clinical examination practice sections and practical surgical skill trainings are not currently covered as reported by the participants. This finding is similar to a previous report from the US where neurosurgery residents admitted that virtual conferencing limited hands-on training and surgical skill acquisition.[23] In addition, poor internet connectivity as reported in this study may be a significant contributor to the participants' decision to prefer physical meetings over virtual VVC. This point must be emphasized because it still characterizes the Nigerian environment, where a plan to deploy 5G network across the country is still on paper (draft consultation document for the deployment of fifth Mobile technology in Nigeria).[24]

Though a lower proportion of participants (55.1%) preferred VVC to physical meetings it is worthy of note. This preference is likely due to its good attributes of being convenient, allows more consultant participation, is easily accessible where there is good internet access, not associated with road traffic accidents, allows interaction while observing social distancing, and enhances punctuality as reported by the majority of respondents. These good features may explain why 83.7% of the participants agreed to recommend VVC for academic residency programs for other training centers.

While being convenient was the commonest reason reported for preferring VVC over physical meetings, the ability of physical meetings to cover all aspects of residency training is the commonest reason for its preference over VVC. Convenience as reported in this study may be because participants could sit in the comfort of their homes to attend academic programs, without being exposed to the risk of accidents and at the same time limits the spread of COVID-19 infection. The ability of physical meeting to cover all aspects of residents' training is an important factor worthy of note. This is because it does not only qualify trainees for examinations, it also determines the quality of training received by these doctors.

Since 54.6% of the respondents were satisfied with the use of VVC for academic residency programs, this is high. The reason for this high level of satisfaction reported in this study is not clear but may be explained by the fact that the majority of the participants also reported VVC as being convenient. This is similar to the result of a previous survey in the US where participants reported it to be very convenient, more engaging, allowed easy sharing of articles, and use of chatbox for ongoing discussions.[16] Although a small proportion of participants were not satisfied, the reason may be due to poor Internet connectivity which was seen as a major impediment in the utilization of VVC in this study.

When asked to identify impediments to successful VVC in UNTH, almost all participants reported poor internet connectivity as a major impediment. This is not surprising as poor internet access has been reported as a limiting factor in the use of video telemedicine during the COVID-19 pandemic in the USA.[25] However, this was attributed to the point that transfer of videos in real-time may require high capacity Internet access such as 5G networks which currently is still at the draft stage in Nigeria.[24] The implication of this is that the quality of videos/presentations may be low and could indirectly lead to poor learning. Poor interaction/discussion was also reported by many participants as an impediment to successful VVC. This finding is in support of a previous report which showed that VVC limits human interactions, affections, and emotions.[22] The implication of this is that with prolonged use, dissatisfaction and lack of interest may set-in. Although, only a few participants reported that the inability to monitor lateness/attendance is an impediment to VVC, it is a critical factor in every training institution and must be highlighted. Poor monitoring of attendance or lateness may be attributed to a lack of adequate experience with the online delivery mechanisms. Therefore, with continued use or training, this problem could be sorted out.

Limitation

None inclusion of a question on lack of power supply to charge participant's device battery may have introduced a bias in determining the exact impediments to the use of VVC.


  Conclusion Top


Despite the improved level of participation of resident doctors and consultants in VVC for academic activities since the COVID-19 outbreak, VVC is strongly limited by poor internet connectivity. Most residents and consultants prefer physical meeting over VVC because it covers all aspects of their training.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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