E-Learning as an Alternative to Face-to-Face Teaching in Postgraduate Medical Education in a Resource-Limited Setting: Lessons from the COVID- 19 Pandemic – Experience from a Tertiary Teaching Hospital in Ethiopia

Background The need for applying physical distancing in the era of COVID-19 greatly hampered conventional face-to-face classroom teaching. This necessitated the incorporation of electronic learning (E-learning) in postgraduate medical education to ensure training continuity of residency programs. However, the perception of medical residents towards this new E-learning approach is not well studied. We assessed the perceived satisfaction of residents and the barriers to implementing E-learning in postgraduate medical education. Methods We conducted a cross-sectional study from July 1 to December 30, 2020, among 200 residents from the departments of Internal Medicine, Surgery, Orthopedics, Neurology, and Obstetrics andGynecology (OBGYN) at the School of Medicine of Addis Ababa University. Self-administered questionnaires were used tocollect data on perception of E-learning and factors that affected it. Data were entered using Epidata and analyzed using Stata 14.0. Factor analysis determined 21 items from six components explained 65% of data variation. Multivariable logistic regression analysis was fitted to identify factors associated with the six components of satisfaction. Results Among the 200 participants, 71.5% were male; 35.5% and 29.5% were from the Surgery and Internal Medicine departments, respectively. The median age of the participants was29 years. Only 24% of the participants had prior E-learning experience before the pandemic, and 15.5% reported spending > 10% of their salary to access the internet for academic purposes. About half (51.5%) of the participants reported satisfaction with E-learning, and 43% supported that E-learning improved teacher-learner collaboration. Satisfaction with E-learning was less among Surgery and OBGYN residents compared to residents from Internal Medicine [AOR:0.3;95% CI 0.11–0.85] and [AOR:0.1;95% CI 0.03–0.4], respectively. In addition, high internet cost, using a mobile device for internet access, poor computer skills, and lack of prior E-learning exposure were all negatively associated with perceived E-learning experience Conclusion Experiences of residents and their perceptions on E-learning were mixed. E-learning as a substitute to face-to-face classroom learning was unpopular especially among Surgery and OBGYN residents. Several barriers to E-learning were identified. We recommend university departments to tailor E-learning teaching methods and interventions and improve infrastructure and resident computer skills to enhance current E-learning experiences. Clinical Trial Number: Not Applicable