Introduction

COVID-19 (acronym derived from the English CO-rona VI-rus D-isease and the year of identification-19) is an infectious disease caused by the new coronavirus (SARS-CoV-2), transmitted through contact with droplets of saliva, by aerosols produced by the airways, or contact with contaminated surfaces (1,2). In recent months, the infection has spread to several countries globally, being responsible for the pandemic (3,4,5,6). As there are still no specific therapies (6,7), classic public health measures, such as social isolation, have been recommended by health authorities to contain the spread of the virus (5,8,9). Thus, to avoid gatherings, these measures directly affected educational institutions' closure worldwide (3,6,10,11,12).

With the suspension of activities in the classroom, so that learning was not interrupted, alternatives were created through the improvement and implementation of distance learning (5,9,10,11). Distance learning has been conducted electronically using tools available through digital platforms and using electronic devices (e.g., computers, tablets, and cell phones) and the internet (5,12). Thus, although professors and students are not physically present in the same place, they can interact using digital technology resources (e.g., video calls, video conferencing services' chats, text messaging applications, email, discussion forums).

It is essential to consider that, in the distance learning model, classes are based on essentially didactic content (10,13), so the teaching of students in professions that depend on practical training has been directly affected (13,14), including Dentistry (13). In Dentistry, laboratory activities and clinical care are of paramount importance for training students' manual ability and fine motor skills, in addition to handling and patient-care training. On the other hand, the need to pause clinical activities has become imperative due to the high risk of contamination of aerosols generated in most dental procedures, face-to-face contact with patients, and in the case of dental educational institutions, the number of students and patients together in the same place at the same time, and the lengthy treatment time usually required (6,15). In this way, professors and students have adapted to digital technology and a didactical teaching approach.

In this sense, despite each institution's characteristics concerning the didactic content adjustment for distance learning, the topic deserves a reflection by professors' and students' opinions regarding the teaching-learning process. Thus, this study's objective was to evaluate the perception and feelings experienced by professors and students of undergraduate and graduate students in Dentistry about distance learning during the COVID-19 pandemic.

Materials and methods

The present study was approved by the local Institutional Review Board (CAAE: 32042720.8.0000.5418). All participants agreed to participate in the research and agreed to the informed consent form. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was used in the present study (16).

Study sample

Fifty professors (30 women and 20 men) and fifty-two undergraduate and graduate students (36 women and 16 men) from Brazil, Costa Rica, United States, and Italy participated in the present study. Each group's sample size was sufficient to obtain saturation of the answers; that is when no different information was obtained from the participants' answers in each group (17). All participants had their face-to-face classes suspended in March 2020, when each location's governments implemented physical distance measures. All participants were taking remote lectures when they filled the survey.

In Brazil, the undergraduate program in dentistry is completed in a period of four to five years. In the United States, after obtaining a bachelor's degree in an undergraduate program (e.g., Dental Hygiene), students can take Dentistry, which is a four-year program. In Costa Rica and Italy, the undergraduate program is completed in 6 years. In common with all these programs are the laboratory courses offered from the second year and the clinical internship that has been intensified in the last two years.

Professors and students' interview

For participation in the research, respecting social isolation and quarantine, professors' and students' approach was carried out through an invitation with a link to the Google Forms questionnaire (Alphabet Co., Mountain View, CA, USA) sent by email or WhastApp (Mountain View, CA, USA) messaging application. The form consisted of demographic data, the date on which the face-to-face classes were suspended, and a section with an open question was used so that the professors and undergraduate and graduate students in Dentistry could describe the perception and feelings experienced about distance learning imposed by the pandemic of COVID-19.

Data analysis

The participants' answers were transcribed and analyzed using the qualitative-quantitative method of the discourse of the collective (17,18) using the Qualiquantisoft software (SPI-Sales & Pascoal Company, São Paulo, Brazil). Initially, one researcher coded all the participants' answers. Two other researchers independently analyzed each group's answers, aiming to identify in more than one perspective the key expressions, that is, the most significant parts of the answers. The key expressions were then compared and synthesized into central ideas by consensus, which were identified by letters of the alphabet and distributed according to the absolute and relative frequency in which they were cited by the participants (17,18). Subsequently, the answers of participants with similar central ideas were grouped, obtaining the collective subject discourse (17,18), obtaining a version for professors (Table 1), and another for students (Table 2).

Results

The average age of professors was 49.2 years, SD=11.6 years (minimum age of 26 and maximum age of 74 years), and among students, it was of 25.33 years, SD=5.7 years (ranging from 18 to 43 years).

The central ideas and the discourse of professors and students' collective subjects are presented in Table 1 and Figure 1, Table 2 and Figure 2, respectively.

Professors considered distance learning suitable for didactical courses but a limited teaching method for lab and clinical courses. Therefore, they thought that it should be used only as a complement to classroom teaching. After an initial period of stress with digital technology applied in distance learning, professors considered that they had learned to use digital resources. However, the persistent difficulty was reconciling classes with domestic activities during social isolation (Table 1).

The professors' concern with distance learning was related to the perception of the lack of motivation and interaction with students, which could be solved using different ways of disseminating the content of the classes (asynchronous or synchronous) (Table 1). They also reported concern about the value of evaluation methods applied in distance learning, with the difficulties of accessing the internet so that students could access the classes' content and the return to face-to-face classes due to the risks of contamination (Table 1).

Some students reported optimism about distance learning and suggested that it should be used in all courses. However, in the same way as the professors, some students reported that distance learning could be applied only for theoretical classes. They considered it a limited teaching method for courses that depended on lab-based and clinical activities, and for that reason, they felt unmotivated. However, they considered distance learning fundamental to guide their studies during the period of social isolation, but this fact depended on the professors' commitment to classes (Table 2).

The students also complained about the lectures' duration and excessive school activities. They also realized that it was difficult for professors to control attendance and evaluations rigorously (Table 2).

Students recognized that some students could have difficulty accessing the internet, which could impact access to classes. They reported that distance learning had the advantage of being comfortable at home, as they did not need to get to the school building (Table 2).

Among graduate students, the main concern was related to the impact educational institutions' closure would bring to their research (Table 2).

Discussion

Despite the presence of digital resources in people's lives, it is crucial to consider that their use in teaching is still associated with a learning curve for many professors and students, who, in the context of the COVID-19 pandemic, had to adapt quickly to migration to an exclusively virtual curriculum (5,12,19). Thus, this study's objective was to verify the opinion of professors and students of Dentistry about distance learning imposed by the pandemic of COVID-19.

Even after initial stress, the professors reported that they learned to use the different digital resources, gaining greater mastery and skill, and considered themselves able to use them. They still intend to use it even with the return of face-to-face activities. So, it is possible to notice a difference between professors and students: the latter did not report such stress related to the migration to the online format or the necessity to improve digital skills. This difference can be attributed to the difference in the groups' average age, with the youngest being more familiar with digital technology. Although young people assimilate the use of digital technology easily (10), the present study's exciting finding was that students did not express professors' enthusiasm with this teaching method, declaring that the absence of practical classes unmotivated them as one of the causes. Also, a previous study (20) observed that students' most significant interest occurred when the subject of didactic classes was taught together with clinical activities.

The students also mentioned difficulty concentrating, probably due to the internet's distractions and the change of focus on digital resources, which were usually more associated with relaxation activities and not with the learning's intense use (10). On the other hand, among professors, the difficulty of concentration was related to domestic activities caused by social isolation (e.g., all family members at home, children's schoolwork, concern about contamination, and worrying news about the pandemic). Students could be experiencing a similar situation, with families confined to their homes, siblings concerned about the economic situation or health condition, and the lack of an appropriate environment for distance learning at home (21); however, this has not been directly reported.

Besides, students pointed out the difficulty of studying alone as a cause of demotivation. It is noteworthy that in distance learning, different from in-classroom lectures, there is a change in the learning process, moving from the professor's central figure to active, self-directed learning centered on the student (8,11,22). It is observed that although this is a crucial competence to stimulate lifelong learning among health professionals (11), this adaptation process takes time to be assimilated. One of the distance learning methods that stimulate this learning process is asynchronous sessions because the content is recorded. Later on, students can observe it at any time of the day, establishing a study routine (12). On the other hand, some students reported excessive school activities requested by professors, making distance learning exhausting and challenging to create a study schedule.

Another challenge of distance learning is developing interaction between professors and students (22). The lack of immediate feedback is an inconvenience as it does not allow professors to assess students' understanding (12). The results of the present study corroborate these statements, although digital platforms provide resources for this interaction. In this sense, aiming for meaningful interaction with students, professors reported the benefits of synchronous classes. When classes are transmitted live, it allows more significant dynamics between professors and students (8). However, some platforms' resources are being underused because there is resistance from students to participate in classes with turned-on cameras and microphones, which increases the lack of interaction.

Another interesting fact mentioned by the students was that the virtual classes seemed longer than the in-person lectures. Some studies suggest (11,23) that students' time tends to be shorter than face-to-face classes in distance learning. In this sense, to improve students' motivation, it is suggested to prepare more concise lectures, using active teaching methodologies and inverted learning. These could lead to more dynamic classes and increase the interaction between professors and students (11).

Most professors and students' common observation was related to distance learning limitations for courses that require practical activities. Even using stimulating critical thinking methods, such as clinical and scientific article discussions, or clinical procedure videos (4,9,13,19), these are unable to fulfill the requirements for training the interpersonal skills and confidence on patient management (13,14). This issue is a concern mainly for students who have already started the clinical internship (12), as seen in the present study.

Professors' concerns are the possibility of returning to laboratory and clinical classes due to the risks of contamination, the need to remodel the clinic infrastructure, and reduce the number of students per term. Besides, it is also essential to consider that, to return to clinical activities, it will be necessary for students to receive reinforcement in training regarding updates to infection control measures (15,24).

As in face-to-face teaching, the difficulty of encompassing a large volume of content in a divided time with clinical activities (25) suggests prioritizing the theoretical content during this period and improving students' background knowledge before classroom activities return (3,24).

It is noteworthy that in distance learning, in addition to the challenges imposed on professors and students, there is also the need for an adequate internet connection to access the content of the classes (8,11,22). However, this fact may not be a reality, especially in developing countries (9), due to restrictions on internet access (5,9,10), as well as the availability of equipment for connectivity (computer/tablet/cell phone) (10,21). Thus, distance learning may not reach all students' socioeconomic levels, and it is not an equitable form of education in all regions of the world (5).

In addition to affecting various academic areas of dentistry, including patient care and education, the current health crisis has also hampered graduate research (15), with the suspension of most laboratory research or non-essential clinical research (3), as reported by some students. Although laboratory research does not involve direct contact with patients, care must also be taken about health-safety protocols and social distance, aiming at students' and employees' well-being with the resumption of activities (3).

A limitation of the present study was in relation to the non-participation of students from other countries because, despite the efforts of researchers in the dissemination of this research, not all universities provide the email of professors and students. Besides, some universities were in the vacation/recess period when conducting this research.

It is noteworthy that the impacts on dental education shared by professors and students from some countries participating in this study may reflect the enormous challenge that the pandemic of COVID-19 created for educational systems worldwide. Thus, the arguments regarding the perception and feelings experienced with the participants' distance learning in this study can be applied to make this teaching format more efficient. The current pause is an alternative for improving the use of digital technologies and alternative teaching methods (e.g., active methodologies) during distance learning, encouraging professors' creativity and students' greater involvement, resulting in new forms of teaching (3,25).

Conclusion

Although distance learning is an adequate tool to limit contamination during the COVID-19 pandemic, each institution must evaluate and align which format is suitable for each discipline and term/period. Creating hybrid content to facilitate the students' learning is an alternative for taking advantage of digital technologies.

Conflicts of interest

None.

References

Publication Dates

History