This study examined the effect of online education on the scientific level of 352 medical students in Baghdad during the COVID-19 pandemic. Descriptive analysis found most participants were female students from the University of Baghdad. Correlation analysis revealed a statistically significant positive moderate relationship between online education and scientific level. Regression analysis determined online education explained 18.4% of the variance in scientific level. The study concluded that online education had a statistically significant effect on students' scientific level.

1. University of Baghdad
College of Medicine
Shams Salah Mukhlif
Karrar Raafat Arif
Mohammed Nasrat Suliman
Supervisor:
Assistant Prof.
Dr. Najah Kadhum Mohammad

2. 1
Table of content
Table of figure
Figure number Page number
Figure 1 16
Figure 2 19
Acknowledgment: firstly, we would like to express our deep and sincere gratitude to our
research supervisor, Assistant prof. Dr. Najah Kadhum Mohammad for his continued
support and encouragement. Secondly, we would like to record our thanks and
appreciation for all people who helped a lot in finalizing this project directly or indirectly.
Content Page number
Introduction 4
Sample and Methods 7
Result 11
Discussion 21
Limitation, conclusion and
recommendations
24
References 25

3. 2
Background: for a long time, Humans have suffered from several infectious diseases.
COVID-19 is one of them, which is a member of the family coronaviridae. public health
and educational systems are collapsing under coronavirus spread worldwide. The
pandemic and social distancing application has made the education to be taken online. In
the other hand, it had disturbed the traditional medical training of medical students.
Aim of the study: To illustrate the effect of skipping the live sessions as an important
educational way on the scientific level of the undergraduate medical students in Baghdad.
Sample & Methods: A sample of 352 of medical students from different universities all
settled in Baghdad governorate, Iraq republic. The study targeted those students whose
education was affected during COVID-19 pandemic. The study involved students from
3rd,4th,5th and 6th stages only.
Results: The study results showed that there is statistically significant positive moderate
relationship (p<0.01) between online education (the independent variable) and the student
scientific level (the dependent variable), and this relationship is functional. In another
word, the online education is an influencing factor and it has a statistically significant
effect(p<0.01) on the scientific level of students.
Conclusion: Online teaching is a quickly growing educational approach. it has enabled
the continuation of medical education during these unprecedented times. The study
results showed that there is a statistically significant positive moderate relationship
between online education and the scientific level of medical students. Moreover, the
online education is an influencing factor which has a statistically significant effect on the
scientific level of students.
Keywords: COVID-19, online education, scientific level, live session, medical students.
Abstract

4. 3
Research methodology
Chapter one
Introduction

5. 4
Introduction
Humans have suffered from lethal infectious diseases, including viral outbreaks, for
a long time. The newly identified coronavirus which was named “COVID-19”by the
WHO is a member of the family coronaviridae the same family of severe acute
respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome
coronavirus (MERS-CoV). COVID-19 was first recognized in Wuhan, Hubei Province,
in China in December 2019 and may be originated from eating wildlife. the virus has
spread worldwide that the WHO declared this disease to be a public health emergency of
international concern, considered as a pandemic. It results in a severe threat to public
health and safety. Although the route for viral transmission remains a mystery, COVID19
may have originated in an animal reservoir, likely that of bat. The clinical features of
COVID-19, such as fever, cough, shortness of breath, and fatigue, are similar to those of
many acute respiratory infections. There is currently no specific treatment for COVID19,
but antiviral therapy combined with supportive care is the main strategy (1)
.
According to the WHO, COVID-19 virus spreads primarily through droplets of
saliva or discharge from the nose when an infected person coughs or sneezes, as a result
the best way to prevent and slow down transmission is by social distancing (2)
. The
nationwide lockdown restrictions to control the spread of disease and flatten the curve
have affected all aspects of life (3)
. The COVID-19 pandemic has caused a sudden shift
towards the online teaching, considered as the primary source of medical education and
enabling students to continue to learn remotely (4)
. The UNESCO reported that 192
countries had applied the lockdown closures, affecting about 99.9% of the world students
populations (5)
. Therefore, it is likely that e-learning and online teaching will continue to
form vital sources of medical education (6)
.
.

6. 5
The pandemic has disrupted the traditional medical training of medical students.
Suspension of large-group, on-site lectures is certainly needed to flatten the curve of
COVID-19 transmission. Therefore, on-site sessions have been suspended to keep
learners safe and clinical medicine is increasingly being practiced virtually, with the
onsite sessions restricted. Another key component of medical education for trainees is
hands-on patient care applied by teaching rounds, this aspect is best accomplished
through face to face interaction (6)
. The pandemic has limited the availability of bedside
teaching opportunities for medical students. As the education has become online, another
challenge has arisen which is the poor internet connection that became a new obstacle
facing the online educational system (7)
.
The COVID-19 pandemic has put us in a unique situation to evaluate the
significance of online teaching platforms in medical education. till now no study has
investigated the outlook of medical students on the effect of these changes in Iraq, Thus
we aim to examine the effect of online education on the students understanding and
education since no previous time in history had such a sudden shift to e-learning (8)
.
Although there are certain deficiencies such as the weakness of online infrastructure,
the inexperience of lecturers regarding online teaching, the stressful situation with which
we are dealing and etc., but in the other hand there are some positive features of online
education like it is less time consuming process regarding the time wasted in crowded
traffics, the student is in a more comfortable place at home and so on. Other study found
that having an idea about the student’s opinion about online education will makes
considerable contribution through its findings by revealing the difference between
various groups of students and their opinion regarding online education. This will present
important information to educational authorities and lecturers about the importance of
online modes of education as a means of up-skilling the online teaching abilities and to
strengthen the educational program (9)
.

7. 6
*the questionnaire and the coding table links will be provided with the “supplementary data” .
Chapter two
Sample & Methods

8. 7
Sample & Methods
A sample of 352 students from different Iraqi universities in Baghdad governorate,
as the study was meant to target undergraduate students who are studying medicine
specifically. The study included third, fourth, fifth and sixth grades students only. The
universities involved were 6 include (University of Baghdad college of medicine,
University of Baghdad Al-Kindy college of medicine, University of Nahrain college of
medicine, University of Mustanseria college of medicine, Iraqia University college of
medicine, Ibn Sina University college of medicine ) all settled in Baghdad governorate.
This is a cross-sectional study conducted via an online survey, A 20-item
questionnaire was devised to explain the effect of online education during COVID-19
pandemic on the Iraqi medical students in Baghdad. the sample was meant to be
convenient sample
The questionnaire* was designed by the authors of the study using ‘Google forms’
platform. and distributed through social media in order to facilitate participation
maintaining social distancing and health guidelines . The questionnaire was accessible for
students to fill it for only 3 days period (from 03 February 2021 to 06 February 2021).
Later on, the data were collected and analyzed statistically using IBM SPSS statistics
program version 22 to exclude final results that will give an indication for the acceptance
or rejection of the research hypotheses.
The questions were divided into three sections, the first one consist of 4 questions
with different patterns and this section targeted some personal information of the
participants (such as name, gender, stage that they belong to, and current university). The
second section of the questionnaire involved 8 questions refers to students perception and
reliance on online education(such as participation ,interaction and etc.). However, the last
section that which also consist of 8 questions were designated to measure the students

9. 8
own knowledge and scientific level according to their education during the pandemic
including the benefits and barriers of online education ”E-learning”. Both sections two
and three were designed in form of 5-point Likert-type questions, ranging from strongly
disagree to strongly agree.
Inclusion criteria: This study was conducted among
• Undergraduate medical students.
• Those who belong to 3rd
, 4th
,5th
and 6th
grades only.
Exclusion criteria: the following criteria were eliminated by the researchers for being
non-eligible to be included.
• Those who are not being undergraduate medical students.
• 1st
and 2nd
grade students.
• Those who are not studying medicine in Baghdad.
Ethical issues: Consents were taken from participants, and they were informed prior to
starting the survey that all data collected was non-identifiable and would only be used for
research purposes.

10. 9
Analytic approach:
The study aims to find out if there is a relationship between the study variables these are
the online education -as an independent variable- and the scientific level -as a dependent
variable- of medical students in Baghdad during COVID-19 pandemic. To prove this,
The researchers stated two main hypotheses as follows:
1- HO = There is NO statistically significant relationship between the 2
variables.
HA = There is statistically significant relationship between the 2 variables.
2- HO = the online education has NO statistically significant effect on the
scientific level.
HA = the online education has a statistically significant effect on the scientific
level.
At first, data was exported from google forms to Microsoft Excel. in Excel, the whole
data were encoded* by specific numbers to be managed in SPSS later on.
The analysis models that were used in the study to exclude results are:
1- Descriptive statistics: used to outline the general details for the sample under
study accomplished with accomplished with graphs and charts that exhibit the
exact frequency and percentage for each variable.
2- Simple linear correlation: used to check weather if there is a relationship
between the study variables or not.
3- Simple linear regression: the researchers fit a regression model to assess the
strength and nature of the relationship between the study variables.

11. 10
Research methodology
Chapter three
Results

12. 11
Results
From a sample of 352 medical students from different Iraqi universities in Baghdad
governorate, data were collected and analyzed using SPSS program to get study
outcomes. Undesirable responses were eliminated as being ineligible.
A- Descriptive statistics:
Gender
Table(1) frequency of males and females among study population
Frequency Percent Cumulative Percent
Male 133 37.8 37.8
Female 219 62.2 100.0
Total 352
100.0
Table(1): from a sample of 352 student ,the table above shows that the percentage of
male respondents to the questionnaire amounted to 37.8% and this represents only 133
from total, while the percentage of females who participated in answering the
questionnaire from various medical colleges in Iraqi universities in Baghdad was 62.2%
and this represents 219 from the total. As a result females participants were more than
males.

13. 12
University
Table(2) Frequency of universities of students (study population).
Frequency Percent
Cumulative
Percent
University of Baghdad COM 171 48.6 48.6
University of Al-Mustansiriya COM 85 24.1 72.7
University of Baghdad Al-Kindy COM 63 17.9 90.6
University of Al-Nahrain COM 21 6.0 96.6
Al-Iraqia University COM 10 2.8 99.4
Ibn Sina University for medical sciences 2 .6 100.0
Total 352 100.0
Table(2): from the table above above the results shows that University of Baghdad
occupied the first place with 171 students (48.6%) out from total number of
participants.in the second place came University of Mustanseria with 85
students(24.1%).Gradually the third university was University of Baghdad Al-Kindy with
63 student(17.9%).fourth place went to University of Nahrain with 21 students(6%).at
fifth place Iraqi University with 10 students(2.8%).While Ibn Sina University for medical
sciences came in the last place with only 2 students(0.6%) out of total number of
participant from all universities.

14. 13
Table(3): From the table above, it is clear that the number of respondents from the third
stage students is the most numerous, as they included the number of 147 students
(41.8%), then came in second place the students of the fourth stage with a number of 131
students (37.2%) of the total number of students participating in the questionnaire and
came in the third place the students of the fifth stage With 58 students (16.5%) of the
total number of participating students, and sixth grade students with 16 students (4.5%)
of the total number of students participating in the questionnaire.
Stage
Table(3) Stages of students (study population).
Frequency Percent Cumulative Percent
Third(3rd) stage 147 41.8 41.8
Forth(4th) stage 131 37.2 79.0
Fifth(5th) stage 58 16.5 95.5
Sixth(6th) stage 16 4.5 100.0
Total 352 100.0

15. 14
B- Analytic Statistics:
1- Simple linear correlation: This type of analysis was used for the purpose of measuring
a specific coefficient which is the linear or Pearson correlation coefficient(R), this
coefficient is useful in the measurement of linear relationship between the scientific
level of students and online education.
(Table4): from the table above the mean of answers that refers to the independent
variable which is the online education was 2.80 with a standard deviation of 0.75 that
means there is a near consensus in students responses on learning online during COVID-
19 pandemic. While mean of responses on the dependent variable which is the scientific
level of students was 3.16 with st.deviation of 0.53. again, this is a small value of
deviation in responses that belongs to the scientific level of students. With taking into
consideration that there are some responses that deviate significantly from each variable
mean. And this will be explained in figure(1) clearly.
Bivariate simple linear correlation
Table(4) Descriptive Statistics
Mean St. Deviation N
Online education mean 2.802 .74844 352
Student scientific level
mean
3.1637 .53465 352

16. 15
(Table5): from the table above, the linear correlation coefficient equals +0.429, and
(P<0.001).from these results we can confidently say that there is a statistically significant
Positive Moderate linear relationship between the study variables those are the online
education and the student scientific level at significant level of 0.01. as a result we reject
the first null hypothesis and accept the alternative hypothesis.
Table(5) Correlations
Online
education
mean
Student
scientific
level mean
Online education mean Pearson Correlation 1 .429**
Sig. (2-tailed) .000
N 352 352
St. scientific level mean Pearson Correlation .429** 1
Sig. (2-tailed) .000
N 352 352
** Correlation is significant at the 0.01 level (2-tailed).

17. 16
Figure(1)dependent and independent means distribution(Study variables)
(Figure1): the figure above gives an idea for R value and the nature of relationship
between the variables understudy. each dot those who are distributed in the scatter
diagram reflects the mean of participants’ responses. In summary we can say that there is
a positive moderate correlation between the variables those are the online education and
the students scientific level.

18. 17
2- Simple linear regression: A regression model has already used in this study to see if
the online education successfully predicts an outcome or the scientific level of
students. regression in concept is an analysis to explore a functional relationship
between variables.
Simple linear regression
Table(6) Model Summary
Model R R
Square
Adjusted R
Square
Std. Error of
the Estimate
1 .429 a
.184 .181 .48372
a. Predictors: (Constant), online education mean
(Table6): from table above R value represents the simple linear correlation coefficient
value that equals 0.429.
R square is the determination coefficient in this out put it equals 0.184 or 18.4%.
therefore, we can say 18.4% of variance in the scientific level of medical students can be
explained by online education. Therefore, the online education is a predictor that really
affects the scientific level of students.

19. 18
Table(7) ANOVAb
(F-test)
Model Sum of
Squares
df Mean Square
F Sig.
Regression 18.438 1 18.438 78.802 .000a
Residual 81.894 350 .234
Total 100.332 351
a. Predictors: (Constant), education
b. Dependent Variable: level
(Table7): ANOVA model tests the statistical significance of the regression model. as
p<0.05 then we reject the second main research null hypothesis which states that online
education variable has NO statistically significant effect on the scientific level variable.
And accept the alternative hypothesis which states that the online education variable has
a statistically significant effect on the scientific level of students.

20. 19
(Figure2): Each dot in the scatter diagram above Represents the responses of students
and how it is deviated from the regression trend. We can easily notice the homogeneity of
most of responses along with the trend. This gives an indication for the agreement of
most respondents that there is a real effect of online education on their scientific level.

21. 20
Research methodology
Chapter four
Discussion

22. 21
Discussion
The rise of COVID-19 results in shifting the education system to online teaching and
learning all over the world (11)
.
Medical education needs face to face interaction especially in practical sessions and
because of the application of online education and social distancing instructions, the
online education had affected somehow in students’ scientific level. Up to our
knowledge, till now no study has investigated the perspective of medical students on the
effect of these changes in Iraq. Thus the study aims to examine the effect of online
education on the medical students scientific level since no previous time in history had
such a sudden shift to e-learning.
This study recruited 352 medical students from different universities in Baghdad,
Iraq. While Al-Balas study “Distance learning in clinical medical education amid
COVID-19 pandemic in Jordan: current situation, challenges, and perspectives” recruited
around 652 students from all medical universities in Jordan (10)
. Dost S, Hossain A,
Shehab M, et al. Conducted a study in UK about “Perceptions of medical students
towards online teaching during the COVID-19 pandemic: a national cross- sectional
survey of 2721 UK medical students” and the sample size was 2721 medical students
across 39 medical school responded (11)
. The sample of this study is fair enough because
it was conducted among medical students from 3rd to 6th stages and among medical
students in Baghdad only through an online questionnaire and unlike this study, the
studies mentioned above were conducted among medical students in all stages and among
medical students in whole universities of the country. In the other hand, a study from
Saudi Arabia “Medical students’ acceptance and perceptions of e-learning during the
Covid-19 closure time in King Abdul-Aziz University, Jeddah” the sample size was 340
medical students, although the sample was collected from one university (12)
.

23. 22
We think that this was because the researcher was a professor in the university and
this will increase the acceptance of students to participate in the study.
This study is investigating the perspective of undergraduate medical students about
the presence of relationship between online education and scientific level. The results has
shown that there is a positive moderate linear relationship(P<0.01) between online
education and the student scientific level. The results revealed that the online education
can statistically effect on the medical students scientific level with a percentage of 18.4%
with highly significant level(P<0.01). Finally, this study reject the null hypotheses.
As mentioned previously there is positive effect of online education on scientific
level of students since there is no other solution in this situation other than e-learning.
Similarly, study from Saudi Arabia “Medical students’ acceptance and perceptions of
elearning during the Covid-19 closure time in King Abdul-Aziz University, Jeddah”
found that the participants agreed that e-learning substituted on-class learning during the
closure time (12)
. However, Khalil et al. Found that there is overall high satisfaction with
e-learning (13)
. Another reason of positive effect of online education that it is less time
consuming educational process. As Jordanian study reported that the main advantage of
e-learning from the perspective of their students was the time saving (10)
. Additionally, the
rise in external resources and teaching programs such as osmosis, pathoma lectures,
lecturio, khan academy etc. had an impact in facilitating the learning process to the
students. Al-Balas study suggest that one of the most important advantage of e-learning is
the easier and faster update and distribution of educational content in comparison to
printed references (10)
. Furthermore, online education has given the chance to the students
to ask questions freely without feeling stressed or anxious (14)
.
The effect of online education on improvement of scientific level of students was not
very remarkable since there were some barriers. The most important one is poor internet

24. 23
connection and technical errors. Khalil et al. Found that one of the most common barrier
was technical insufficiency including poor internet connectivity and deficits in educators'
basic computer skills (13)
. Furthermore, Gaikwad, et al. Suggests that the lack of adequate
personal computer skills was an obstacle (15)
. Lakbala reported that the lack of proper
training on e-learning and the limited communication with the instructor were the most
critical barrier (16)
. Another important disadvantage is the restriction of clinical and
practical sessions that are important in medical practice especially for gaining important
medical skills and self confidence in front of the patient. Khalil, et al. Suggest that
nothing can replace seeing patients because clinical experience and human interaction are
extremely important for the practice of medicine (13)
. Study from Saudi Arabia “Medical
students’ acceptance and perceptions of e-learning during the Covid-19 closure time in
King Abdul-Aziz University, Jeddah”, found that clinical skills is the most challenging
learning outcome and might be not suitable for e-learning (12)
, This result agrees with the
result of Regmi and Jones (17)
. Also online education affected the self-discipline of the
students since there is no follow-up by their supervisors, agrees with the result of Regmi
and Jones (17)
. Moreover, the pandemic and social distancing might affect the
psychological status of the students due to lack of interactions with friends and colleagues
leading to the feeling of anxiety. Cao W, Fang Z, Hou G, et al. Found that the mental
health of students, recently shown to be impacted by the COVID-19 (18)
. Of all the
reasons that have been mentioned in this chapter, all of them are considered as obstacles
that may stand in the way of education of medical students.

25. 24
Limitations: the sample size could be a limitation for some reasons including study
population was only restricted to Baghdad governorate. However, Some medical colleges
may have been disproportionately represented with larger numbers of responses from
some colleges, for example, University of Baghdad COM compared with Ibn Sina or Al-
Iraqia University COM. This condition called sample bias. so that the study results may
not be generalizable to whole community population.
Conclusion and Recommendations: Online teaching is a quickly growing educational
approach. it has enabled the continuation of medical education during these
unprecedented times. The study results showed that there is a statistically significant
positive moderate relationship between online education and the scientific level of
medical students. Moreover, the online education is an influencing factor which has a
statistically significant effect on the scientific level of students. Additionally, Researchers
recommend medical students to adapt and depend more on online education. the sample
size is suggested to be increased and include more student from different universities in
Iraq in order increase the accuracy of study results and decrease sample bias That
researchers may encounter. future studies should highlight other factors that may affect
the medical students scientific level and education such as their mental and physical
status. Finally, in order to improve the efficacy of medical education in the future,
medical colleges should depend on blended learning and resort to teaching formats like
team-based learning.

26. 25
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10- Al-Balas M, Al-Balas HI, Jaber HM, Obeidat K et al. Distance learning in clinical
medical education amid COVID-19 pandemic in Jordan: current situation,
challenges, and perspectives. BMC Med Educ. 2020;20(1):341.Epub 2020 Oct02.
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acceptance and perceptions of e-learning during the Covid-19 closure time in King
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28. 27
Supplementary data:
1- Questionnaire:https://docs.google.com/forms/d/1pPDxg6IhQ5xicX5VY8e-1Dd-
WL0UPuurespwwYm_pGQ/ .
2- Coding table:
https://docs.google.com/document/d/1tCYa4iNASDsxzdJL358PxuJXTgy1tDO5/ .

29. 28
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،
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.
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:
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:
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.
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‫ﻛ‬
‫ﺎ‬
‫ظ‬
‫ﻢ‬
‫ﻣ‬
‫ﺤ‬
‫ﻤ‬
‫ﺪ‬

30. 29