online study during covid 19 essay

The COVID-19 pandemic has changed education forever. This is how 

With schools shut across the world, millions of children have had to adapt to new types of learning. Image:  REUTERS/Gonzalo Fuentes

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Stay up to date:.

• The COVID-19 has resulted in schools shut all across the world. Globally, over 1.2 billion children are out of the classroom.
• As a result, education has changed dramatically, with the distinctive rise of e-learning, whereby teaching is undertaken remotely and on digital platforms.
• Research suggests that online learning has been shown to increase retention of information, and take less time, meaning the changes coronavirus have caused might be here to stay.

While countries are at different points in their COVID-19 infection rates, worldwide there are currently more than 1.2 billion children in 186 countries affected by school closures due to the pandemic. In Denmark, children up to the age of 11 are returning to nurseries and schools after initially closing on 12 March , but in South Korea students are responding to roll calls from their teachers online .

With this sudden shift away from the classroom in many parts of the globe, some are wondering whether the adoption of online learning will continue to persist post-pandemic, and how such a shift would impact the worldwide education market.

Even before COVID-19, there was already high growth and adoption in education technology, with global edtech investments reaching US$18.66 billion in 2019 and the overall market for online education projected to reach $350 Billion by 2025 . Whether it is language apps , virtual tutoring , video conferencing tools, or online learning software , there has been a significant surge in usage since COVID-19.

How is the education sector responding to COVID-19?

In response to significant demand, many online learning platforms are offering free access to their services, including platforms like BYJU’S , a Bangalore-based educational technology and online tutoring firm founded in 2011, which is now the world’s most highly valued edtech company . Since announcing free live classes on its Think and Learn app, BYJU’s has seen a 200% increase in the number of new students using its product, according to Mrinal Mohit, the company's Chief Operating Officer.

Tencent classroom, meanwhile, has been used extensively since mid-February after the Chinese government instructed a quarter of a billion full-time students to resume their studies through online platforms. This resulted in the largest “online movement” in the history of education with approximately 730,000 , or 81% of K-12 students, attending classes via the Tencent K-12 Online School in Wuhan.

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Other companies are bolstering capabilities to provide a one-stop shop for teachers and students. For example, Lark, a Singapore-based collaboration suite initially developed by ByteDance as an internal tool to meet its own exponential growth, began offering teachers and students unlimited video conferencing time, auto-translation capabilities, real-time co-editing of project work, and smart calendar scheduling, amongst other features. To do so quickly and in a time of crisis, Lark ramped up its global server infrastructure and engineering capabilities to ensure reliable connectivity.

Alibaba’s distance learning solution, DingTalk, had to prepare for a similar influx: “To support large-scale remote work, the platform tapped Alibaba Cloud to deploy more than 100,000 new cloud servers in just two hours last month – setting a new record for rapid capacity expansion,” according to DingTalk CEO, Chen Hang.

Some school districts are forming unique partnerships, like the one between The Los Angeles Unified School District and PBS SoCal/KCET to offer local educational broadcasts, with separate channels focused on different ages, and a range of digital options. Media organizations such as the BBC are also powering virtual learning; Bitesize Daily , launched on 20 April, is offering 14 weeks of curriculum-based learning for kids across the UK with celebrities like Manchester City footballer Sergio Aguero teaching some of the content.

What does this mean for the future of learning?

While some believe that the unplanned and rapid move to online learning – with no training, insufficient bandwidth, and little preparation – will result in a poor user experience that is unconducive to sustained growth, others believe that a new hybrid model of education will emerge, with significant benefits. “I believe that the integration of information technology in education will be further accelerated and that online education will eventually become an integral component of school education,“ says Wang Tao, Vice President of Tencent Cloud and Vice President of Tencent Education.

There have already been successful transitions amongst many universities. For example, Zhejiang University managed to get more than 5,000 courses online just two weeks into the transition using “DingTalk ZJU”. The Imperial College London started offering a course on the science of coronavirus, which is now the most enrolled class launched in 2020 on Coursera .

Many are already touting the benefits: Dr Amjad, a Professor at The University of Jordan who has been using Lark to teach his students says, “It has changed the way of teaching. It enables me to reach out to my students more efficiently and effectively through chat groups, video meetings, voting and also document sharing, especially during this pandemic. My students also find it is easier to communicate on Lark. I will stick to Lark even after coronavirus, I believe traditional offline learning and e-learning can go hand by hand."

These 3 charts show the global growth in online learning

The challenges of online learning.

There are, however, challenges to overcome. Some students without reliable internet access and/or technology struggle to participate in digital learning; this gap is seen across countries and between income brackets within countries. For example, whilst 95% of students in Switzerland, Norway, and Austria have a computer to use for their schoolwork, only 34% in Indonesia do, according to OECD data .

In the US, there is a significant gap between those from privileged and disadvantaged backgrounds: whilst virtually all 15-year-olds from a privileged background said they had a computer to work on, nearly 25% of those from disadvantaged backgrounds did not. While some schools and governments have been providing digital equipment to students in need, such as in New South Wales , Australia, many are still concerned that the pandemic will widenthe digital divide .

Is learning online as effective?

For those who do have access to the right technology, there is evidence that learning online can be more effective in a number of ways. Some research shows that on average, students retain 25-60% more material when learning online compared to only 8-10% in a classroom. This is mostly due to the students being able to learn faster online; e-learning requires 40-60% less time to learn than in a traditional classroom setting because students can learn at their own pace, going back and re-reading, skipping, or accelerating through concepts as they choose.

Nevertheless, the effectiveness of online learning varies amongst age groups. The general consensus on children, especially younger ones, is that a structured environment is required , because kids are more easily distracted. To get the full benefit of online learning, there needs to be a concerted effort to provide this structure and go beyond replicating a physical class/lecture through video capabilities, instead, using a range of collaboration tools and engagement methods that promote “inclusion, personalization and intelligence”, according to Dowson Tong, Senior Executive Vice President of Tencent and President of its Cloud and Smart Industries Group.

Since studies have shown that children extensively use their senses to learn, making learning fun and effective through use of technology is crucial, according to BYJU's Mrinal Mohit. “Over a period, we have observed that clever integration of games has demonstrated higher engagement and increased motivation towards learning especially among younger students, making them truly fall in love with learning”, he says.

A changing education imperative

It is clear that this pandemic has utterly disrupted an education system that many assert was already losing its relevance . In his book, 21 Lessons for the 21st Century , scholar Yuval Noah Harari outlines how schools continue to focus on traditional academic skills and rote learning , rather than on skills such as critical thinking and adaptability, which will be more important for success in the future. Could the move to online learning be the catalyst to create a new, more effective method of educating students? While some worry that the hasty nature of the transition online may have hindered this goal, others plan to make e-learning part of their ‘new normal’ after experiencing the benefits first-hand.

The importance of disseminating knowledge is highlighted through COVID-19

Major world events are often an inflection point for rapid innovation – a clear example is the rise of e-commerce post-SARS . While we have yet to see whether this will apply to e-learning post-COVID-19, it is one of the few sectors where investment has not dried up . What has been made clear through this pandemic is the importance of disseminating knowledge across borders, companies, and all parts of society. If online learning technology can play a role here, it is incumbent upon all of us to explore its full potential.

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How to Write About Coronavirus in a College Essay

Students can share how they navigated life during the coronavirus pandemic in a full-length essay or an optional supplement.

Writing About COVID-19 in College Essays

Getty Images

Experts say students should be honest and not limit themselves to merely their experiences with the pandemic.

The global impact of COVID-19, the disease caused by the novel coronavirus, means colleges and prospective students alike are in for an admissions cycle like no other. Both face unprecedented challenges and questions as they grapple with their respective futures amid the ongoing fallout of the pandemic.

Colleges must examine applicants without the aid of standardized test scores for many – a factor that prompted many schools to go test-optional for now . Even grades, a significant component of a college application, may be hard to interpret with some high schools adopting pass-fail classes last spring due to the pandemic. Major college admissions factors are suddenly skewed.

"I can't help but think other (admissions) factors are going to matter more," says Ethan Sawyer, founder of the College Essay Guy, a website that offers free and paid essay-writing resources.

College essays and letters of recommendation , Sawyer says, are likely to carry more weight than ever in this admissions cycle. And many essays will likely focus on how the pandemic shaped students' lives throughout an often tumultuous 2020.

But before writing a college essay focused on the coronavirus, students should explore whether it's the best topic for them.

Writing About COVID-19 for a College Application

Much of daily life has been colored by the coronavirus. Virtual learning is the norm at many colleges and high schools, many extracurriculars have vanished and social lives have stalled for students complying with measures to stop the spread of COVID-19.

"For some young people, the pandemic took away what they envisioned as their senior year," says Robert Alexander, dean of admissions, financial aid and enrollment management at the University of Rochester in New York. "Maybe that's a spot on a varsity athletic team or the lead role in the fall play. And it's OK for them to mourn what should have been and what they feel like they lost, but more important is how are they making the most of the opportunities they do have?"

That question, Alexander says, is what colleges want answered if students choose to address COVID-19 in their college essay.

But the question of whether a student should write about the coronavirus is tricky. The answer depends largely on the student.

"In general, I don't think students should write about COVID-19 in their main personal statement for their application," Robin Miller, master college admissions counselor at IvyWise, a college counseling company, wrote in an email.

"Certainly, there may be exceptions to this based on a student's individual experience, but since the personal essay is the main place in the application where the student can really allow their voice to be heard and share insight into who they are as an individual, there are likely many other topics they can choose to write about that are more distinctive and unique than COVID-19," Miller says.

Opinions among admissions experts vary on whether to write about the likely popular topic of the pandemic.

"If your essay communicates something positive, unique, and compelling about you in an interesting and eloquent way, go for it," Carolyn Pippen, principal college admissions counselor at IvyWise, wrote in an email. She adds that students shouldn't be dissuaded from writing about a topic merely because it's common, noting that "topics are bound to repeat, no matter how hard we try to avoid it."

Above all, she urges honesty.

"If your experience within the context of the pandemic has been truly unique, then write about that experience, and the standing out will take care of itself," Pippen says. "If your experience has been generally the same as most other students in your context, then trying to find a unique angle can easily cross the line into exploiting a tragedy, or at least appearing as though you have."

But focusing entirely on the pandemic can limit a student to a single story and narrow who they are in an application, Sawyer says. "There are so many wonderful possibilities for what you can say about yourself outside of your experience within the pandemic."

He notes that passions, strengths, career interests and personal identity are among the multitude of essay topic options available to applicants and encourages them to probe their values to help determine the topic that matters most to them – and write about it.

That doesn't mean the pandemic experience has to be ignored if applicants feel the need to write about it.

Writing About Coronavirus in Main and Supplemental Essays

Students can choose to write a full-length college essay on the coronavirus or summarize their experience in a shorter form.

To help students explain how the pandemic affected them, The Common App has added an optional section to address this topic. Applicants have 250 words to describe their pandemic experience and the personal and academic impact of COVID-19.

"That's not a trick question, and there's no right or wrong answer," Alexander says. Colleges want to know, he adds, how students navigated the pandemic, how they prioritized their time, what responsibilities they took on and what they learned along the way.

If students can distill all of the above information into 250 words, there's likely no need to write about it in a full-length college essay, experts say. And applicants whose lives were not heavily altered by the pandemic may even choose to skip the optional COVID-19 question.

"This space is best used to discuss hardship and/or significant challenges that the student and/or the student's family experienced as a result of COVID-19 and how they have responded to those difficulties," Miller notes. Using the section to acknowledge a lack of impact, she adds, "could be perceived as trite and lacking insight, despite the good intentions of the applicant."

To guard against this lack of awareness, Sawyer encourages students to tap someone they trust to review their writing , whether it's the 250-word Common App response or the full-length essay.

Experts tend to agree that the short-form approach to this as an essay topic works better, but there are exceptions. And if a student does have a coronavirus story that he or she feels must be told, Alexander encourages the writer to be authentic in the essay.

"My advice for an essay about COVID-19 is the same as my advice about an essay for any topic – and that is, don't write what you think we want to read or hear," Alexander says. "Write what really changed you and that story that now is yours and yours alone to tell."

Sawyer urges students to ask themselves, "What's the sentence that only I can write?" He also encourages students to remember that the pandemic is only a chapter of their lives and not the whole book.

Miller, who cautions against writing a full-length essay on the coronavirus, says that if students choose to do so they should have a conversation with their high school counselor about whether that's the right move. And if students choose to proceed with COVID-19 as a topic, she says they need to be clear, detailed and insightful about what they learned and how they adapted along the way.

"Approaching the essay in this manner will provide important balance while demonstrating personal growth and vulnerability," Miller says.

Pippen encourages students to remember that they are in an unprecedented time for college admissions.

"It is important to keep in mind with all of these (admission) factors that no colleges have ever had to consider them this way in the selection process, if at all," Pippen says. "They have had very little time to calibrate their evaluations of different application components within their offices, let alone across institutions. This means that colleges will all be handling the admissions process a little bit differently, and their approaches may even evolve over the course of the admissions cycle."

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• Published: 27 September 2021

Why lockdown and distance learning during the COVID-19 pandemic are likely to increase the social class achievement gap

• Sébastien Goudeau   ORCID: orcid.org/0000-0001-7293-0977 1 ,
• Camille Sanrey   ORCID: orcid.org/0000-0003-3158-1306 1 ,
• Arnaud Stanczak   ORCID: orcid.org/0000-0002-2596-1516 2 ,
• Antony Manstead   ORCID: orcid.org/0000-0001-7540-2096 3 &
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The COVID-19 pandemic has forced teachers and parents to quickly adapt to a new educational context: distance learning. Teachers developed online academic material while parents taught the exercises and lessons provided by teachers to their children at home. Considering that the use of digital tools in education has dramatically increased during this crisis, and it is set to continue, there is a pressing need to understand the impact of distance learning. Taking a multidisciplinary view, we argue that by making the learning process rely more than ever on families, rather than on teachers, and by getting students to work predominantly via digital resources, school closures exacerbate social class academic disparities. To address this burning issue, we propose an agenda for future research and outline recommendations to help parents, teachers and policymakers to limit the impact of the lockdown on social-class-based academic inequality.

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The widespread effects of the COVID-19 pandemic that emerged in 2019–2020 have drastically increased health, social and economic inequalities 1 , 2 . For more than 900 million learners around the world, the pandemic led to the closure of schools and universities 3 . This exceptional situation forced teachers, parents and students to quickly adapt to a new educational context: distance learning. Teachers had to develop online academic materials that could be used at home to ensure educational continuity while ensuring the necessary physical distancing. Primary and secondary school students suddenly had to work with various kinds of support, which were usually provided online by their teachers. For college students, lockdown often entailed returning to their hometowns while staying connected with their teachers and classmates via video conferences, email and other digital tools. Despite the best efforts of educational institutions, parents and teachers to keep all children and students engaged in learning activities, ensuring educational continuity during school closure—something that is difficult for everyone—may pose unique material and psychological challenges for working-class families and students.

Not only did the pandemic lead to the closure of schools in many countries, often for several weeks, it also accelerated the digitalization of education and amplified the role of parental involvement in supporting the schoolwork of their children. Thus, beyond the specific circumstances of the COVID-19 lockdown, we believe that studying the effects of the pandemic on academic inequalities provides a way to more broadly examine the consequences of school closure and related effects (for example, digitalization of education) on social class inequalities. Indeed, bearing in mind that (1) the risk of further pandemics is higher than ever (that is, we are in a ‘pandemic era’ 4 , 5 ) and (2) beyond pandemics, the use of digital tools in education (and therefore the influence of parental involvement) has dramatically increased during this crisis, and is set to continue, there is a pressing need for an integrative and comprehensive model that examines the consequences of distance learning. Here, we propose such an integrative model that helps us to understand the extent to which the school closures associated with the pandemic amplify economic, digital and cultural divides that in turn affect the psychological functioning of parents, students and teachers in a way that amplifies academic inequalities. Bringing together research in social sciences, ranging from economics and sociology to social, cultural, cognitive and educational psychology, we argue that by getting students to work predominantly via digital resources rather than direct interactions with their teachers, and by making the learning process rely more than ever on families rather than teachers, school closures exacerbate social class academic disparities.

First, we review research showing that social class is associated with unequal access to digital tools, unequal familiarity with digital skills and unequal uses of such tools for learning purposes 6 , 7 . We then review research documenting how unequal familiarity with school culture, knowledge and skills can also contribute to the accentuation of academic inequalities 8 , 9 . Next, we present the results of surveys conducted during the 2020 lockdown showing that the quality and quantity of pedagogical support received from schools varied according to the social class of families (for examples, see refs. 10 , 11 , 12 ). We then argue that these digital, cultural and structural divides represent barriers to the ability of parents to provide appropriate support for children during distance learning (Fig. 1 ). These divides also alter the levels of self-efficacy of parents and children, thereby affecting their engagement in learning activities 13 , 14 . In the final section, we review preliminary evidence for the hypothesis that distance learning widens the social class achievement gap and we propose an agenda for future research. In addition, we outline recommendations that should help parents, teachers and policymakers to use social science research to limit the impact of school closure and distance learning on the social class achievement gap.

Economic, structural, digital and cultural divides influence the psychological functioning of parents and students in a way that amplify inequalities.

The digital divide

Unequal access to digital resources.

Although the use of digital technologies is almost ubiquitous in developed nations, there is a digital divide such that some people are more likely than others to be numerically excluded 15 (Fig. 1 ). Social class is a strong predictor of digital disparities, including the quality of hardware, software and Internet access 16 , 17 , 18 . For example, in 2019, in France, around 1 in 5 working-class families did not have personal access to the Internet compared with less than 1 in 20 of the most privileged families 19 . Similarly, in 2020, in the United Kingdom, 20% of children who were eligible for free school meals did not have access to a computer at home compared with 7% of other children 20 . In 2021, in the United States, 41% of working-class families do not own a laptop or desktop computer and 43% do not have broadband compared with 8% and 7%, respectively, of upper/middle-class Americans 21 . A similar digital gap is also evident between lower-income and higher-income countries 22 .

Second, simply having access to a computer and an Internet connection does not ensure effective distance learning. For example, many of the educational resources sent by teachers need to be printed, thereby requiring access to printers. Moreover, distance learning is more difficult in households with only one shared computer compared with those where each family member has their own 23 . Furthermore, upper/middle-class families are more likely to be able to guarantee a suitable workspace for each child than their working-class counterparts 24 .

In the context of school closures, such disparities are likely to have important consequences for educational continuity. In line with this idea, a survey of approximately 4,000 parents in the United Kingdom confirmed that during lockdown, more than half of primary school children from the poorest families did not have access to their own study space and were less well equipped for distance learning than higher-income families 10 . Similarly, a survey of around 1,300 parents in the Netherlands found that during lockdown, children from working-class families had fewer computers at home and less room to study than upper/middle-class children 11 .

Data from non-Western countries highlight a more general digital divide, showing that developing countries have poorer access to digital equipment. For example, in India in 2018, only 10.7% of households possessed a digital device 25 , while in Pakistan in 2020, 31% of higher-education teachers did not have Internet access and 68.4% did not have a laptop 26 . In general, developing countries lack access to digital technologies 27 , 28 , and these difficulties of access are even greater in rural areas (for example, see ref. 29 ). Consequently, school closures have huge repercussions for the continuity of learning in these countries. For example, in India in 2018, only 11% of the rural and 40% of the urban population above 14 years old could use a computer and access the Internet 25 . Time spent on education during school closure decreased by 80% in Bangladesh 30 . A similar trend was observed in other countries 31 , with only 22% of children engaging in remote learning in Kenya 32 and 50% in Burkina Faso 33 . In Ghana, 26–32% of children spent no time at all on learning during the pandemic 34 . Beyond the overall digital divide, social class disparities are also evident in developing countries, with lower access to digital resources among households in which parental educational levels were low (versus households in which parental educational levels were high; for example, see ref. 35 for Nigeria and ref. 31 for Ecuador).

Unequal digital skills

In addition to unequal access to digital tools, there are also systematic variations in digital skills 36 , 37 (Fig. 1 ). Upper/middle-class families are more familiar with digital tools and resources and are therefore more likely to have the digital skills needed for distance learning 38 , 39 , 40 . These digital skills are particularly useful during school closures, both for students and for parents, for organizing, retrieving and correctly using the resources provided by the teachers (for example, sending or receiving documents by email, printing documents or using word processors).

Social class disparities in digital skills can be explained in part by the fact that children from upper/middle-class families have the opportunity to develop digital skills earlier than working-class families 41 . In member countries of the OECD (Organisation for Economic Co-operation and Development), only 23% of working-class children had started using a computer at the age of 6 years or earlier compared with 43% of upper/middle-class children 42 . Moreover, because working-class people tend to persist less than upper/middle-class people when confronted with digital difficulties 23 , the use of digital tools and resources for distance learning may interfere with the ability of parents to help children with their schoolwork.

Unequal use of digital tools

A third level of digital divide concerns variations in digital tool use 18 , 43 (Fig. 1 ). Upper/middle-class families are more likely to use digital resources for work and education 6 , 41 , 44 , whereas working-class families are more likely to use these resources for entertainment, such as electronic games or social media 6 , 45 . This divide is also observed among students, whereby working-class students tend to use digital technologies for leisure activities, whereas their upper/middle-class peers are more likely to use them for academic activities 46 and to consider that computers and the Internet provide an opportunity for education and training 23 . Furthermore, working-class families appear to regulate the digital practices of their children less 47 and are more likely to allow screens in the bedrooms of children and teenagers without setting limits on times or practices 48 .

In sum, inequalities in terms of digital resources, skills and use have strong implications for distance learning. This is because they make working-class students and parents particularly vulnerable when learning relies on extensive use of digital devices rather than on face-to-face interaction with teachers.

The cultural divide

Even if all three levels of digital divide were closed, upper/middle-class families would still be better prepared than working-class families to ensure educational continuity for their children. Upper/middle-class families are more familiar with the academic knowledge and skills that are expected and valued in educational settings, as well as with the independent, autonomous way of learning that is valued in the school culture and becomes even more important during school closure (Fig. 1 ).

Unequal familiarity with academic knowledge and skills

According to classical social reproduction theory 8 , 49 , school is not a neutral place in which all forms of language and knowledge are equally valued. Academic contexts expect and value culture-specific and taken-for-granted forms of knowledge, skills and ways of being, thinking and speaking that are more in tune with those developed through upper/middle-class socialization (that is, ‘cultural capital’ 8 , 50 , 51 , 52 , 53 ). For instance, academic contexts value interest in the arts, museums and literature 54 , 55 , a type of interest that is more likely to develop through socialization in upper/middle-class families than in working-class socialization 54 , 56 . Indeed, upper/middle-class parents are more likely than working-class parents to engage in activities that develop this cultural capital. For example, they possess more books and cultural objects at home, read more stories to their children and visit museums and libraries more often (for examples, see refs. 51 , 54 , 55 ). Upper/middle-class children are also more involved in extra-curricular activities (for example, playing a musical instrument) than working-class children 55 , 56 , 57 .

Beyond this implicit familiarization with the school curriculum, upper/middle-class parents more often organize educational activities that are explicitly designed to develop academic skills of their children 57 , 58 , 59 . For example, they are more likely to monitor and re-explain lessons or use games and textbooks to develop and reinforce academic skills (for example, labelling numbers, letters or colours 57 , 60 ). Upper/middle-class parents also provide higher levels of support and spend more time helping children with homework than working-class parents (for examples, see refs. 61 , 62 ). Thus, even if all parents are committed to the academic success of their children, working-class parents have fewer chances to provide the help that children need to complete homework 63 , and homework is more beneficial for children from upper-middle class families than for children from working-class families 64 , 65 .

School closures amplify the impact of cultural inequalities

The trends described above have been observed in ‘normal’ times when schools are open. School closures, by making learning rely more strongly on practices implemented at home (rather than at school), are likely to amplify the impact of these disparities. Consistent with this idea, research has shown that the social class achievement gap usually greatly widens during school breaks—a phenomenon described as ‘summer learning loss’ or ‘summer setback’ 66 , 67 , 68 . During holidays, the learning by children tends to decline, and this is particularly pronounced in children from working-class families. Consequently, the social class achievement gap grows more rapidly during the summer months than it does in the rest of the year. This phenomenon is partly explained by the fact that during the break from school, social class disparities in investment in activities that are beneficial for academic achievement (for example, reading, travelling to a foreign country or museum visits) are more pronounced.

Therefore, when they are out of school, children from upper/middle-class backgrounds may continue to develop academic skills unlike their working-class counterparts, who may stagnate or even regress. Research also indicates that learning loss during school breaks tends to be cumulative 66 . Thus, repeated episodes of school closure are likely to have profound consequences for the social class achievement gap. Consistent with the idea that school closures could lead to similar processes as those identified during summer breaks, a recent survey indicated that during the COVID-19 lockdown in the United Kingdom, children from upper/middle-class families spent more time on educational activities (5.8 h per day) than those from working-class families (4.5 h per day) 7 , 69 .

Unequal dispositions for autonomy and self-regulation

School closures have encouraged autonomous work among students. This ‘independent’ way of studying is compatible with the family socialization of upper/middle-class students, but does not match the interdependent norms more commonly associated with working-class contexts 9 . Upper/middle-class contexts tend to promote cultural norms of independence whereby individuals perceive themselves as autonomous actors, independent of other individuals and of the social context, able to pursue their own goals 70 . For example, upper/middle-class parents tend to invite children to express their interests, preferences and opinions during the various activities of everyday life 54 , 55 . Conversely, in working-class contexts characterized by low economic resources and where life is more uncertain, individuals tend to perceive themselves as interdependent, connected to others and members of social groups 53 , 70 , 71 . This interdependent self-construal fits less well with the independent culture of academic contexts. This cultural mismatch between interdependent self-construal common in working-class students and the independent norms of the educational institution has negative consequences for academic performance 9 .

Once again, the impact of these differences is likely to be amplified during school closures, when being able to work alone and autonomously is especially useful. The requirement to work alone is more likely to match the independent self-construal of upper/middle-class students than the interdependent self-construal of working-class students. In the case of working-class students, this mismatch is likely to increase their difficulties in working alone at home. Supporting our argument, recent research has shown that working-class students tend to underachieve in contexts where students work individually compared with contexts where students work with others 72 . Similarly, during school closures, high self-regulation skills (for example, setting goals, selecting appropriate learning strategies and maintaining motivation 73 ) are required to maintain study activities and are likely to be especially useful for using digital resources efficiently. Research has shown that students from working-class backgrounds typically develop their self-regulation skills to a lesser extent than those from upper/middle-class backgrounds 74 , 75 , 76 .

Interestingly, some authors have suggested that independent (versus interdependent) self-construal may also affect communication with teachers 77 . Indeed, in the context of distance learning, working-class families are less likely to respond to the communication of teachers because their ‘interdependent’ self leads them to respect hierarchies, and thus perceive teachers as an expert who ‘can be trusted to make the right decisions for learning’. Upper/middle class families, relying on ‘independent’ self-construal, are more inclined to seek individualized feedback, and therefore tend to participate to a greater extent in exchanges with teachers. Such cultural differences are important because they can also contribute to the difficulties encountered by working-class families.

The structural divide: unequal support from schools

The issues reviewed thus far all increase the vulnerability of children and students from underprivileged backgrounds when schools are closed. To offset these disadvantages, it might be expected that the school should increase its support by providing additional resources for working-class students. However, recent data suggest that differences in the material and human resources invested in providing educational support for children during periods of school closure were—paradoxically—in favour of upper/middle-class students (Fig. 1 ). In England, for example, upper/middle-class parents reported benefiting from online classes and video-conferencing with teachers more often than working-class parents 10 . Furthermore, active help from school (for example, online teaching, private tutoring or chats with teachers) occurred more frequently in the richest households (64% of the richest households declared having received help from school) than in the poorest households (47%). Another survey found that in the United Kingdom, upper/middle-class children were more likely to take online lessons every day (30%) than working-class students (16%) 12 . This substantial difference might be due, at least in part, to the fact that private schools are better equipped in terms of online platforms (60% of schools have at least one online platform) than state schools (37%, and 23% in the most deprived schools) and were more likely to organize daily online lessons. Similarly, in the United Kingdom, in schools with a high proportion of students eligible for free school meals, teachers were less inclined to broadcast an online lesson for their pupils 78 . Interestingly, 58% of teachers in the wealthiest areas reported having messaged their students or their students’ parents during lockdown compared with 47% in the most deprived schools. In addition, the probability of children receiving technical support from the school (for example, by providing pupils with laptops or other devices) is, surprisingly, higher in the most advantaged schools than in the most deprived 78 .

In addition to social class disparities, there has been less support from schools for African-American and Latinx students. During school closures in the United States, 40% of African-American students and 30% of Latinx students received no online teaching compared with 10% of white students 79 . Another source of inequality is that the probability of school closure was correlated with social class and race. In the United States, for example, school closures from September to December 2020 were more common in schools with a high proportion of racial/ethnic minority students, who experience homelessness and are eligible for free/discounted school meals 80 .

Similarly, access to educational resources and support was lower in poorer (compared with richer) countries 81 . In sub-Saharan Africa, during lockdown, 45% of children had no exposure at all to any type of remote learning. Of those who did, the medium was mostly radio, television or paper rather than digital. In African countries, at most 10% of children received some material through the Internet. In Latin America, 90% of children received some remote learning, but less than half of that was through the internet—the remainder being via radio and television 81 . In Ecuador, high-school students from the lowest wealth quartile had fewer remote-learning opportunities, such as Google class/Zoom, than students from the highest wealth quartile 31 .

Thus, the achievement gap and its accentuation during lockdown are due not only to the cultural and digital disadvantages of working-class families but also to unequal support from schools. This inequality in school support is not due to teachers being indifferent to or even supportive of social stratification. Rather, we believe that these effects are fundamentally structural. In many countries, schools located in upper/middle-class neighbourhoods have more money than those in the poorest neighbourhoods. Moreover, upper/middle-class parents invest more in the schools of their children than working-class parents (for example, see ref. 82 ), and schools have an interest in catering more for upper/middle-class families than for working-class families 83 . Additionally, the expectation of teachers may be lower for working-class children 84 . For example, they tend to estimate that working-class students invest less effort in learning than their upper/middle-class counterparts 85 . These differences in perception may have influenced the behaviour of teachers during school closure, such that teachers in privileged neighbourhoods provided more information to students because they expected more from them in term of effort and achievement. The fact that upper/middle-class parents are better able than working-class parents to comply with the expectations of teachers (for examples, see refs. 55 , 86 ) may have reinforced this phenomenon. These discrepancies echo data showing that working-class students tend to request less help in their schoolwork than upper/middle-class ones 87 , and they may even avoid asking for help because they believe that such requests could lead to reprimands 88 . During school closures, these students (and their families) may in consequence have been less likely to ask for help and resources. Jointly, these phenomena have resulted in upper/middle-class families receiving more support from schools during lockdown than their working-class counterparts.

Psychological effects of digital, cultural and structural divides

Despite being strongly influenced by social class, differences in academic achievement are often interpreted by parents, teachers and students as reflecting differences in ability 89 . As a result, upper/middle-class students are usually perceived—and perceive themselves—as smarter than working-class students, who are perceived—and perceive themselves—as less intelligent 90 , 91 , 92 or less able to succeed 93 . Working-class students also worry more about the fact that they might perform more poorly than upper/middle-class students 94 , 95 . These fears influence academic learning in important ways. In particular, they can consume cognitive resources when children and students work on academic tasks 96 , 97 . Self-efficacy also plays a key role in engaging in learning and perseverance in the face of difficulties 13 , 98 . In addition, working-class students are those for whom the fear of being outperformed by others is the most negatively related to academic performance 99 .

The fact that working-class children and students are less familiar with the tasks set by teachers, and less well equipped and supported, makes them more likely to experience feelings of incompetence (Fig. 1 ). Working-class parents are also more likely than their upper/middle-class counterparts to feel unable to help their children with schoolwork. Consistent with this, research has shown that both working-class students and parents have lower feelings of academic self-efficacy than their upper/middle-class counterparts 100 , 101 . These differences have been documented under ‘normal’ conditions but are likely to be exacerbated during distance learning. Recent surveys conducted during the school closures have confirmed that upper/middle-class families felt better able to support their children in distance learning than did working-class families 10 and that upper/middle-class parents helped their children more and felt more capable to do so 11 , 12 .

Pandemic disparity, future directions and recommendations

The research reviewed thus far suggests that children and their families are highly unequal with respect to digital access, skills and use. It also shows that upper/middle-class students are more likely to be supported in their homework (by their parents and teachers) than working-class students, and that upper/middle-class students and parents will probably feel better able than working-class ones to adapt to the context of distance learning. For all these reasons, we anticipate that as a result of school closures, the COVID-19 pandemic will substantially increase the social class achievement gap. Because school closures are a recent occurrence, it is too early to measure with precision their effects on the widening of the achievement gap. However, some recent data are consistent with this idea.

Evidence for a widening gap during the pandemic

Comparing academic achievement in 2020 with previous years provides an early indication of the effects of school closures during the pandemic. In France, for example, first and second graders take national evaluations at the beginning of the school year. Initial comparisons of the results for 2020 with those from previous years revealed that the gap between schools classified as ‘priority schools’ (those in low-income urban areas) and schools in higher-income neighbourhoods—a gap observed every year—was particularly pronounced in 2020 in both French and mathematics 102 .

Similarly, in the Netherlands, national assessments take place twice a year. In 2020, they took place both before and after school closures. A recent analysis compared progress during this period in 2020 in mathematics/arithmetic, spelling and reading comprehension for 7–11-year-old students within the same period in the three previous years 103 . Results indicated a general learning loss in 2020. More importantly, for the 8% of working-class children, the losses were 40% greater than they were for upper/middle-class children.

Similar results were observed in Belgium among students attending the final year of primary school. Compared with students from previous cohorts, students affected by school closures experienced a substantial decrease in their mathematics and language scores, with children from more disadvantaged backgrounds experiencing greater learning losses 104 . Likewise, oral reading assessments in more than 100 school districts in the United States showed that the development of this skill among children in second and third grade significantly slowed between Spring and Autumn 2020, but this slowdown was more pronounced in schools from lower-achieving districts 105 .

It is likely that school closures have also amplified racial disparities in learning and achievement. For example, in the United States, after the first lockdown, students of colour lost the equivalent of 3–5 months of learning, whereas white students were about 1–3 months behind. Moreover, in the Autumn, when some students started to return to classrooms, African-American and Latinx students were more likely to continue distance learning, despite being less likely to have access to the digital tools, Internet access and live contact with teachers 106 .

In some African countries (for example, Ethiopia, Kenya, Liberia, Tanzania and Uganda), the COVID-19 crisis has resulted in learning loss ranging from 6 months to more 1 year 107 , and this learning loss appears to be greater for working-class children (that is, those attending no-fee schools) than for upper/middle-class children 108 .

These findings show that school closures have exacerbated achievement gaps linked to social class and ethnicity. However, more research is needed to address the question of whether school closures differentially affect the learning of students from working- and upper/middle-class families.

Future directions

First, to assess the specific and unique impact of school closures on student learning, longitudinal research should compare student achievement at different times of the year, before, during and after school closures, as has been done to document the summer learning loss 66 , 109 . In the coming months, alternating periods of school closure and opening may occur, thereby presenting opportunities to do such research. This would also make it possible to examine whether the gap diminishes a few weeks after children return to in-school learning or whether, conversely, it increases with time because the foundations have not been sufficiently acquired to facilitate further learning 110 .

Second, the mechanisms underlying the increase in social class disparities during school closures should be examined. As discussed above, school closures result in situations for which students are unevenly prepared and supported. It would be appropriate to seek to quantify the contribution of each of the factors that might be responsible for accentuating the social class achievement gap. In particular, distinguishing between factors that are relatively ‘controllable’ (for example, resources made available to pupils) and those that are more difficult to control (for example, the self-efficacy of parents in supporting the schoolwork of their children) is essential to inform public policy and teaching practices.

Third, existing studies are based on general comparisons and very few provide insights into the actual practices that took place in families during school closure and how these practices affected the achievement gap. For example, research has documented that parents from working-class backgrounds are likely to find it more difficult to help their children to complete homework and to provide constructive feedback 63 , 111 , something that could in turn have a negative impact on the continuity of learning of their children. In addition, it seems reasonable to assume that during lockdown, parents from upper/middle-class backgrounds encouraged their children to engage in practices that, even if not explicitly requested by teachers, would be beneficial to learning (for example, creative activities or reading). Identifying the practices that best predict the maintenance or decline of educational achievement during school closures would help identify levers for intervention.

Finally, it would be interesting to investigate teaching practices during school closures. The lockdown in the spring of 2020 was sudden and unexpected. Within a few days, teachers had to find a way to compensate for the school closure, which led to highly variable practices. Some teachers posted schoolwork on platforms, others sent it by email, some set work on a weekly basis while others set it day by day. Some teachers also set up live sessions in large or small groups, providing remote meetings for questions and support. There have also been variations in the type of feedback given to students, notably through the monitoring and correcting of work. Future studies should examine in more detail what practices schools and teachers used to compensate for the school closures and their effects on widening, maintaining or even reducing the gap, as has been done for certain specific literacy programmes 112 as well as specific instruction topics (for example, ecology and evolution 113 ).

Practical recommendations

We are aware of the debate about whether social science research on COVID-19 is suitable for making policy decisions 114 , and we draw attention to the fact that some of our recommendations (Table 1 ) are based on evidence from experiments or interventions carried out pre-COVID while others are more speculative. In any case, we emphasize that these suggestions should be viewed with caution and be tested in future research. Some of our recommendations could be implemented in the event of new school closures, others only when schools re-open. We also acknowledge that while these recommendations are intended for parents and teachers, their implementation largely depends on the adoption of structural policies. Importantly, given all the issues discussed above, we emphasize the importance of prioritizing, wherever possible, in-person learning over remote learning 115 and where this is not possible, of implementing strong policies to support distance learning, especially for disadvantaged families.

Where face-to face teaching is not possible and teachers are responsible for implementing distance learning, it will be important to make them aware of the factors that can exacerbate inequalities during lockdown and to provide them with guidance about practices that would reduce these inequalities. Thus, there is an urgent need for interventions aimed at making teachers aware of the impact of the social class of children and families on the following factors: (1) access to, familiarity with and use of digital devices; (2) familiarity with academic knowledge and skills; and (3) preparedness to work autonomously. Increasing awareness of the material, cultural and psychological barriers that working-class children and families face during lockdown should increase the quality and quantity of the support provided by teachers and thereby positively affect the achievements of working-class students.

In addition to increasing the awareness of teachers of these barriers, teachers should be encouraged to adjust the way they communicate with working-class families due to differences in self-construal compared with upper/middle-class families 77 . For example, questions about family (rather than personal) well-being would be congruent with interdependent self-construals. This should contribute to better communication and help keep a better track of the progress of students during distance learning.

It is also necessary to help teachers to engage in practices that have a chance of reducing inequalities 53 , 116 . Particularly important is that teachers and schools ensure that homework can be done by all children, for example, by setting up organizations that would help children whose parents are not in a position to monitor or assist with the homework of their children. Options include homework help groups and tutoring by teachers after class. When schools are open, the growing tendency to set homework through digital media should be resisted as far as possible given the evidence we have reviewed above. Moreover, previous research has underscored the importance of homework feedback provided by teachers, which is positively related to the amount of homework completed and predictive of academic performance 117 . Where homework is web-based, it has also been shown that feedback on web-based homework enhances the learning of students 118 . It therefore seems reasonable to predict that the social class achievement gap will increase more slowly (or even remain constant or be reversed) in schools that establish individualized monitoring of students, by means of regular calls and feedback on homework, compared with schools where the support provided to pupils is more generic.

Given that learning during lockdown has increasingly taken place in family settings, we believe that interventions involving the family are also likely to be effective 119 , 120 , 121 . Simply providing families with suitable material equipment may be insufficient. Families should be given training in the efficient use of digital technology and pedagogical support. This would increase the self-efficacy of parents and students, with positive consequences for achievement. Ideally, such training would be delivered in person to avoid problems arising from the digital divide. Where this is not possible, individualized online tutoring should be provided. For example, studies conducted during the lockdown in Botswana and Italy have shown that individual online tutoring directly targeting either parents or students in middle school has a positive impact on the achievement of students, particularly for working-class students 122 , 123 .

Interventions targeting families should also address the psychological barriers faced by working-class families and children. Some interventions have already been designed and been shown to be effective in reducing the social class achievement gap, particularly in mathematics and language 124 , 125 , 126 . For example, research showed that an intervention designed to train low-income parents in how to support the mathematical development of their pre-kindergarten children (including classes and access to a library of kits to use at home) increased the quality of support provided by the parents, with a corresponding impact on the development of mathematical knowledge of their children. Such interventions should be particularly beneficial in the context of school closure.

Beyond its impact on academic performance and inequalities, the COVID-19 crisis has shaken the economies of countries around the world, casting millions of families around the world into poverty 127 , 128 , 129 . As noted earlier, there has been a marked increase in economic inequalities, bringing with it all the psychological and social problems that such inequalities create 130 , 131 , especially for people who live in scarcity 132 . The increase in educational inequalities is just one facet of the many difficulties that working-class families will encounter in the coming years, but it is one that could seriously limit the chances of their children escaping from poverty by reducing their opportunities for upward mobility. In this context, it should be a priority to concentrate resources on the most deprived students. A large proportion of the poorest households do not own a computer and do not have personal access to the Internet, which has important consequences for distance learning. During school closures, it is therefore imperative to provide such families with adequate equipment and Internet service, as was done in some countries in spring 2020. Even if the provision of such equipment is not in itself sufficient, it is a necessary condition for ensuring pedagogical continuity during lockdown.

Finally, after prolonged periods of school closure, many students may not have acquired the skills needed to pursue their education. A possible consequence would be an increase in the number of students for whom teachers recommend class repetitions. Class repetitions are contentious. On the one hand, class repetition more frequently affects working-class children and is not efficient in terms of learning improvement 133 . On the other hand, accepting lower standards of academic achievement or even suspending the practice of repeating a class could lead to pupils pursuing their education without mastering the key abilities needed at higher grades. This could create difficulties in subsequent years and, in this sense, be counterproductive. We therefore believe that the most appropriate way to limit the damage of the pandemic would be to help children catch up rather than allowing them to continue without mastering the necessary skills. As is being done in some countries, systematic remedial courses (for example, summer learning programmes) should be organized and financially supported following periods of school closure, with priority given to pupils from working-class families. Such interventions have genuine potential in that research has shown that participation in remedial summer programmes is effective in reducing learning loss during the summer break 134 , 135 , 136 . For example, in one study 137 , 438 students from high-poverty schools were offered a multiyear summer school programme that included various pedagogical and enrichment activities (for example, science investigation and music) and were compared with a ‘no-treatment’ control group. Students who participated in the summer programme progressed more than students in the control group. A meta-analysis 138 of 41 summer learning programmes (that is, classroom- and home-based summer interventions) involving children from kindergarten to grade 8 showed that these programmes had significantly larger benefits for children from working-class families. Although such measures are costly, the cost is small compared to the price of failing to fulfil the academic potential of many students simply because they were not born into upper/middle-class families.

The unprecedented nature of the current pandemic means that we lack strong data on what the school closure period is likely to produce in terms of learning deficits and the reproduction of social inequalities. However, the research discussed in this article suggests that there are good reasons to predict that this period of school closures will accelerate the reproduction of social inequalities in educational achievement.

By making school learning less dependent on teachers and more dependent on families and digital tools and resources, school closures are likely to greatly amplify social class inequalities. At a time when many countries are experiencing second, third or fourth waves of the pandemic, resulting in fresh periods of local or general lockdowns, systematic efforts to test these predictions are urgently needed along with steps to reduce the impact of school closures on the social class achievement gap.

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We thank G. Reis for editing the figure. The writing of this manuscript was supported by grant ANR-19-CE28-0007–PRESCHOOL from the French National Research Agency (S.G.).

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Goudeau, S., Sanrey, C., Stanczak, A. et al. Why lockdown and distance learning during the COVID-19 pandemic are likely to increase the social class achievement gap. Nat Hum Behav 5 , 1273–1281 (2021). https://doi.org/10.1038/s41562-021-01212-7

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ORIGINAL RESEARCH article

Expectations and experiences with online education during the covid-19 pandemic in university students.

• 1 Laboratorio de Investigación e Innovación educativa Dirección de Docencia, Universidad de Concepción, Concepción, Chile
• 2 Programa de Doctorado Educación en Consorcio, Universidad de Católica de la Santísima Concepción, Concepción, Chile
• 3 Departamento de Física, Facultad Ciencias Físicas y Matemáticas, Universidad de Concepción, Concepción, Chile
• 4 Departamento Currículum e Instrucción, Facultad de Educación, Universidad de Concepción, Concepción, Chile
• 5 Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile

Due to COVID-19, university students continued their academic training remotely. To assess the effects of emergency remote teaching (ERT), we evaluated the expectations and, subsequently, the experiences of university students about online education. This study employed a simple prospective design as its method. We assessed the expectations of 1,904 students from different discipline areas (1,106 women and 798 men; age M = 21.56; SD = 3.07) during the beginning of the first semester, March 2020 (T1), and their experiences at the end of the same academic period, September 2020 (T2). We used convenience non-probability sampling. Participants responded to the questionnaire on Expectations toward virtual education in higher education for students and the questionnaire on virtual education experiences in higher education. The results showed that students’ responses reflected low expectations regarding peer relationships and comparison with face-to-face education (T1). This perception was maintained during the evaluation of experiences (T2). Students reported positive experiences regarding online teaching and learning, online assessment, and their self-efficacy beliefs at T2. Statistically significant differences between measurements were found, with the expertise presenting higher averages than expectations. Furthermore, differences by gender were identified, reporting a positive change in the scores of women. In addition, results reflected differences according to the disciplinary area, showing Social Sciences and Medical and Health Sciences students a more significant size effect. Findings regarding the empirical evidence and the implications for future teaching scenarios in Higher Education are discussed.

Introduction

Higher education institutions had to face the challenge of providing continuity to the educational process remotely due to the COVID-19 pandemic. This scenario implied a drastic transformation without the possibility of preparation, having both teachers and students quickly develop online education competencies ( Hattar et al., 2021 ). Emergency remote teaching (ERT) is the name given to this instructional response ( Bustamante, 2020 ; Hodges et al., 2020 ). ERT applies to any unexpected and urgent transition to online instruction due to a disaster. Given its nature, one of the characteristics of ERT is the lack of time and skills of instructors to adequately prepare and implement their course syllabus in a virtual format ( Hodges et al., 2020 ). Thus, ERT differs significantly from online teaching, in which the focus is on delivering a quality learning experience following a predefined instructional design ( Miramontes Arteaga et al., 2019 ).

Currently, online courses are created using an instructional design, such as ADDIE, and implemented through Learning Management Systems (LMS), like Canvas. In these courses, designers and teachers apply technological and pedagogical innovations to obtain high-quality standards. In this teaching modality, educational experiences occur synchronously and asynchronously using multiple devices to access the internet. Therefore, students can interact with teachers, content, and peers from wherever they are ( Singh and Thurman, 2019 ). It requires stable digital infrastructure and platforms. Thus, its implementation demands many resources and a carefully designed plan to deliver a quality experience ( Mousa et al., 2020 ). As necessary and valuable as ERT is, its design does not necessarily consider the critical elements of quality online education ( Hodges et al., 2020 ). Despite the advances in online education in many higher education institutions worldwide, universities, in general, were not prepared for the necessary, mandatory, and abrupt change at the onset of the COVID-19 pandemic ( Maier et al., 2020 ).

Quality online teaching considers evaluating course characteristics, including the design of learning materials, the virtual environment, and the alignment of curricular components with learning outcomes. It also considers aspects related to the interaction experience of students with their peers and teachers ( Rodrigues et al., 2019 ).

Literature Review

Due to the COVID-19 pandemic, students’ expectations about how their academic year would unfold were rapidly modified and adjusted. This is relevant due to empirical evidence that supports that student expectations are predictors of academic success ( Paechter et al., 2010 ; Alhabeeb and Rowley, 2018 ; Wei and Chou, 2020 ). Student expectations can be defined as the beliefs that students hold about successfully coping with academic responsibilities. From the perspective of the expectancy-value theory ( Wigfield and Eccles, 2000 ), students have beliefs about their ability and success in meeting academic demands. These beliefs can be impacted by the subjective perception of the value of the academic activity to the student ( Valle et al., 2015 ). The expectancy-value theory is widely used to understand how psychological and contextual factors enhance student engagement and learning outcomes ( Chiu et al., 2021 ). Furthermore, expectations also impact student attitudes about the ways of learning (Fernández Jiménez et al., 2017 ). It has been reported that students’ perceptions regarding online learning modalities are related to their learning success ( Nur Agung et al., 2020 ). Therefore, expectations and experiences of university students regarding online learning courses during the pandemic could translate into opportunities or obstacles in the sense of moving closer or further away from a practical online education experience in the future ( Rodrigues et al., 2019 ; Pham and Ho, 2020 ).

Several studies have reported a variety of results regarding the expectations and subsequent experience of university students. For example, descriptive research conducted with 1612 undergraduates from 59 on-site Spanish universities says that students consider that the institutions did not adapt adequately to the ERT scenario (84%), especially regarding teaching methods and the implementation of assessments (64.5%). Furthermore, they state that the adopted institutional measures were not sufficient, affecting their academic performance (88.5%) during this period. In terms of experience, in the same research, students were not satisfied with virtual education, especially regarding courses’ assessment ( Villa et al., 2020 ). These results relate to another study that reported that students would not repeat this experience due to the absence of interaction with teachers, excess of tasks, and the accelerated pace for learning ( Imsa-ard, 2020 ; Suárez et al., 2021 ).

Consistent with the above, another study indicates that students perceived an overload in their academic responsibilities due to excessive activities and assignments, which made the process more exhausting ( Rahiem, 2020 ). Moreover, another research from the pandemic experience indicates that young people reported a low perception of quality and quantity in their learning during ERT regarding the strategies implemented by their universities, which did not meet their expectations (31.3%) ( Almomani et al., 2021 ). Additionally, researchers found that, unlike men, women perceived greater satisfaction with the strategies implemented by universities (66%), were more committed to delivering their assignments (70.6%), and were more optimistic about the assessment process implemented by teachers in their courses (70.2%) ( Almomani et al., 2021 ). Another research concludes that online teaching during the COVID-19 pandemic was only possible when online learning had a robust digital infrastructure and a learning system designed for that purpose; otherwise, it was an attempt to replicate face-to-face teaching in the virtual environment ( Abdulrahim and Mabrouk, 2020 ).

Despite the emergency scenario caused by the pandemic, not all studies reported negative experiences ( Abdulrahim and Mabrouk, 2020 ; Sepulveda-Escobar and Morrison, 2020 ). During ERT training, students from various institutions worldwide ( N = 30,383) claimed to be satisfied with the support provided by their instructors and institutions. In this case, specific sociodemographic characteristics such as gender, academic area, and other elements of the students favorably impacted these beliefs ( Aristovnik et al., 2020 ). Students positively assessed the actions implemented by the universities’ Information and Communication Technologies Departments ( Shehzadi et al., 2020 ). In addition, they thoroughly evaluated the online platforms used since they allowed them to perform their tasks efficiently and quickly, having fun while studying ( Maier et al., 2020 ). It is important to note that some authors report differences in experiences according to the scientific disciplines to which students belong ( Vladova et al., 2021a ).

Regarding social aspects, it seems that students were not satisfied with the preparation of teachers during the ERT modality due to difficulties in the interaction with their teachers and peers ( Alqurshi, 2020 ; Hamdan et al., 2021 ). This aspect is consistent with other research highlighting the importance of interaction between instructors and students in the online education experience ( Sun, 2016 ; Bao, 2020 ).

Due to ERT, a negative effect on students’ self-efficacy beliefs about online education has been reported at the individual level ( Aldhahi et al., 2021 ), while others found no changes ( Talsma et al., 2021 ). Self-efficacy is a relevant element regarding students’ academic satisfaction and performance ( Cervantes Arreola et al., 2018 ; Hamdan et al., 2021 ). When students believe in successfully facing the challenges of online education, they display a series of mechanisms to favor a more efficient and effective coping of their learning process. Consequently, beliefs conversion during the ERT may play an essential role in post-pandemic online learning.

In the context of the COVID-19, the academic, social, and individual experiences during ERT affect the perception of online education, which could impact the implementation of this modality in Higher Education in the future.

The Present Study

The empirical evidence described highlights the importance of assessing students’ experience during the ERT, especially the quality of the learning experience, the integration of teaching approaches, the design, the application of assessment tools, and how the relationship between students and their teachers is fostered ( Sun, 2016 ; Alqurshi, 2020 ; Aristovnik et al., 2020 ; Bao, 2020 ; Rahiem, 2020 ; Van Heuvelen et al., 2020 ; Villa et al., 2020 ; Almomani et al., 2021 ; Suárez et al., 2021 ). These aspects will provide vital information for the design and implementation of effective online learning processes that respond to the needs of students and universities in this context in the future.

This study focuses on the importance of learning about students’ expectations and experiences during the implementation of the ERT for the COVID-19 pandemic. Specifically, we inquire on how students’ expectations and experiences can affect their academic, social, and personal aspects to provide evidence to support actions for the transition to face-to-face and blended learning. In this context, this research aims to analyze the expectations and experiences of students in a traditional university in the south of Chile at a general level and in consideration of the participants’ gender and disciplinary area.

Based on the above and the heterogeneity of students’ experiences reported in the literature, we describe the following hypotheses:

H 1 . There will be changes in the experiences to the expectations of university students during ERT due to the COVID-19 pandemic.

H 2 . Differences will be found between men and women regarding university students’ expectations and experience scores during the ERT due to the COVID-19 pandemic.

H 3 . Differences in university students’ expectations and experience scores will be observed according to disciplinary areas during ERT due to the COVID-19 pandemic.

Materials and Methods

A simple ex post facto longitudinal quantitative research design was used. Researchers find it impossible to manipulate the independent variable in ex post facto studies, describing the associations between variables. It is simply longitudinal since two measurements were performed, starting by measuring the expectation (March 2020; T1) and then the experience (September 2020; T2) of the students with online education during the ERT, to subsequently study the relationships found between the variables ( Montero and León, 2007 ).

Participants

A total of 1,904 students belonging to a traditional Chilean university participated, of which 1106 (58.1%) were women, and 798 (41.9%) were men, with mean age M = 21.56 ( SD = 3.07). On the other hand, 635 (33.35%) of the participants were in their first academic year. According to their undergraduate program, students’ classification according to the areas of the Organization for Economic Co-operation and Development (OECD) is presented in Table 1 .

Table 1. Distribution of students by gender and disciplinary area.

Instruments

Expectations toward virtual education.

The Expectations toward Virtual Education in Higher Education for Students (CEEVESE) questionnaire aims to know higher education students’ expectations about virtual education during ERT. It consists of 28 items distributed in six dimensions about virtual education. The items were elaborated based on available scientific literature and evaluated employing expert judgment ( Lobos et al., 2022 ). Table 2 describes the dimensions that constitute the scale.

Table 2. Description of the dimensions of the CEEVESE questionnaire.

A Likert scale with five response options (1 = Strongly disagree to 5 = Strongly agree) was employed. The average of each dimension and the full scale was analyzed, in which scores higher than 3 indicate positive expectations. Previous studies have examined the factorial structure of the scale, finding an adequate adjustment of the 6 factors [X 2 (335) = 5354.88, p < 0.001, CFI:0.961; TLI:0.956; SRMR:0.041; RMSEA:0.06]. The reliability analysis of the responses was: peer relationship α = 0.894, online learning α = 0.922; online teaching α = 0.907; self-efficacy for online learning α = 0.882, online assessment α = 0.787; comparison with face-to-face education α = 0.779; full scale: α = 0.954 ( Lobos et al., 2022 ).

Experience in Virtual Education

The Virtual Education Experiences in Higher Education for Students (EEEL) questionnaire adapts the CEEVESE (Lobos et al., under review 1 ). Its purpose is to learn about the experiences of higher education students with virtual education during ERT. It consists of the same 28 items of the CEEVESE but presented in the past tense, using again a Likert scale of 5 response options (1 = Strongly disagree to 5 = Strongly agree). For their interpretation, the averages of each dimension and the full scale were analyzed. In both cases, the presence of scores above 3 points reflects a positive student experience. The items’ distribution corresponds with the six original dimensions.

The factorial structure of this version confirmed an adequate adjustment of the 6 factors [ X 2 (333) = 3599.92, p < 0.001, CFI: 0.966; TLI: 0.961; SRMR: 0.036; RMSEA: 0.059]. Reliability analysis of the responses by dimensions was as follows: peer relationship α = 0.869, online learning α = 0.883; online teaching α = 0.876; self-efficacy for online learning α = 0.872, online assessment α = 0.753; comparison with face-to-face education α = 0.671; full scale: α = 0.931 (Lobos et al., under review, see text footnote 1).

This research was endorsed by the Ethics Committee of the participating university, corroborating the ethical criteria for research with human beings. The expectations and experience instruments were applied in digital format and sent to the students’ institutional emails on a single occasion. For the two measurement moments (T1 and T2), the questionnaires were available for 3 weeks at the beginning of March 2020 and at the end of September 2020. Students responded after reading and signing an informed consent form. A convenience non-probability sampling was used. The participants were students who were enrolled in a course during the first semester of 2020. To track the students, the enrollment number and e-mail address of each participant were compared. Only students presenting both measurements were included.

Analysis Plan

We performed a descriptive analysis of the variables. Verification of the assumption of normality for the dimensions and total scales in both measurements (T1 and T2) was made using the Kolmogorov-Smirnov test with the Lilliefors modification ( Thode, 2002 ). Analyzed data did not have a normal distribution ( p < 0.001). Despite this, the Student’s t -test for paired samples was performed to evaluate the differences in the T1 and T2 scores due to the sample size.

The assumptions were verified using the mixed ANOVA tests to assess the effects between groups on gender and OECD areas versus the intra-group effect (changes between expectations and experience). No extreme outliers were found. Levene’s test was analyzed, finding no significant result ( p > 0.05). The homogeneity of covariance of the between-subjects factor (gender-OECD area) using Box’s M test was also evaluated, with a not statistically significant result ( p > 0.001). Therefore, no violation of the homogeneity of covariances assumption is assumed. Verification of the sphericity assumption was automatic since the Greenhouse-Geisser sphericity correction was applied to violating assumption factors during the ANOVA test calculation.

The size effect was analyzed considering the cutoffs by Cárdenas Castro and Arancibia Martini (2014) , in which scores >0.14 are considered large, 0.06 medium, and 0.01 small. The data analysis was performed with R Studio software version 4.0.3 (2020-10-10) ( R Core Team, 2020 ).

The present research aims to analyze the students’ expectations and experiences, considering the gender and disciplinary area of the participants. We presented the results in the context of the research hypotheses described in section “The Present Study.”

Differences Between University Students’ Expectations and Experiences During Emergency Remote Teaching During the COVID-19 Pandemic

Hypotheses H 1 sought to answer the existence of changes between the expectations and experiences of university students produced by ERT during the COVID-19 pandemic. In the first measurement (T1), the general students’ expectations presented an average below 3 points, identifying them as low ( M = 2.92, SD = 0.65). The dimension that presented the highest score was self-efficacy for online education ( M = 3.42; SD = 0.84), whereas the dimensions that showed the lowest scores were peer relationship ( M = 2.1; SD = 0.83) and comparison with face-to-face teaching ( M = 1.91; SD = 1.07).

Regarding the measurement of the students’ experiences with the ERT after the academic semester (T2), the perception was positive since the score was higher than 3 points ( M = 3.18, SD = 0.66). Furthermore, the analysis by dimensions, identify that dimensions’ averages of the experiences (T2) were higher than its corresponding dimensions of the questionnaire of expectations (T1). However, despite having improved, the dimensions of peer relationship ( M = 2.26, SD = 0.95) and comparison with face-to-face education ( M = 2.71, SD = 1.24) remain as negative perceptions, since scores were still lower than 3. Table 3 shows dimensions’ averages and deviations of the scales applied and the assessment of the differences between them.

Table 3. Descriptive and inferential statistics on students’ expectations and experiences during the ERT.

When performing the comparative analysis between the general expectations of the students (T1) and the experience after the end of the semester (T2), statistically significant differences [ t (1903) = 19, p < 0.001] were found. Hence, students’ experience with ERT at the end of the academic period exceeded their expectations. In this sense, results respond positively to the proposed hypothesis, identifying differences in the scores between T1 and T2.

Gender Differences in University Students’ Expectations and Experiences of Online Learning During Emergency Remote Teaching

To analyze differences between expectations and experiences considering gender and OECD area, the presence of statistically significant bidirectional interactions was assessed. Subsequently, we performed post hoc tests to determine the main effects of gender and OECD area, considering the Bonferroni adjusted p -value.

We examined each dimension independently to answer the hypothesis regarding the existence of differences between expectations and experiences related to undergraduate students’ gender during ERT (H 2 ). The results showed statistically significant bidirectional interactions among gender and the change in scores between expectations and experiences in the following five dimensions: online learning [ F (1,1902) = 19.09, p < 0.001, GES.002]; comparison with face-to-face education [ F (1,1902) = 25.23, p < 0.001, GES.004]; online teaching [ F (1,1902) = 5.31, p < 0.001, GES.0006]; peer relationship [ F (1,1902) = 6.79, p < 0.01]; and self-efficacy for online learning [ F (1,1902) = 4.836, p < 0.05, GES.0006]. In the case of the online assessment dimension, no statistically significant results were observed.

Regarding the main effect of gender, a significant effect for experience, but not for expectations in the following four dimensions was observed online learning: experience [ F (1,1902) = 10.64, p < 0.01, GES.006]. Online teaching: experience [ F (1,1902) = 8.54, p < 0.01, GES.004]. Peer relationship: experience [ F (1,1902) = 6.55, p < 0.05, GES = 0.003] and Self-efficacy for online learning: experience [ F (1,1902) = 5.37, p < 0.05, GES.003].

On the other hand, in the case of comparison with face-to-face education, the results were significant for expectation [ F (1,1902) = 13.06, p < 0.001, GES.007], but not for experience ( p = 0.06).

The simple main effect of the differences between expectations and experience were also analyzed, observing statistically significant results for women and men in four of the dimensions: online learning, women [ F (1,1106) = 203, p < 0.001 GES = 0.046] and men [ F (1,796) = 42.1, p < 0.001 GES = 0.011]. In the Comparison with face-to-face education, women [ F (1,1106) = 589.63, p < 0.001 GES = 0.15] and men [ F (1,796) = 169.09, p < 0.001 GES = 0.06]. In the Online teaching, women [ F (1,1106) = 264, p < 0.001 GES = 0.06] and the men [ F (1,796) = 117, p < 0.001 GES = 0.03]. In the peer relationship, women [ F (1,1106) = 57.5, p < 0.001 GES = 0.014] and men [ F (1,796) = 10.1, p < 0.01 GES = 0.003].

In the self-efficacy for online learning dimension, statistically significant results were identified only for women [ F (1,1106) = 13.4, p < 0.001 GES = 0.003]. Even though men and women presented higher scores at T2, women showed the most significant change reflecting a positive experience with online education (see Table 4 ).

Table 4. Descriptive data on the expectations and experience of university students considering gender.

Figure 1 shows the size effect identified in the measurements considering gender. In the case of women, we found a large-size effect in the dimension of comparison with face-to-face education and a medium-size effect in the online teaching dimension. In the case of men, the analysis outcomes determine only a medium effect size in the dimension of comparison with face-to-face education and a small size effect in the rest of the dimensions.

Figure 1. The effect size of the change between expectations and experience according to the gender of the participating student.

Differences by Disciplinary Area in the Measurement of Undergraduate Students’ Expectations and Experiences of Online Learning During Emergency Remote Teaching

Regarding differences between the scores from expectations and experience of university students during ERT during the COVID-19 pandemic according to disciplinary areas (H 3 ), the results by dimension are presented below.

For all six dimensions a statistically significant bidirectional interactions among the OECD area and the differences between T1 and T2 scores was found. The results by dimensions are the following: Comparison to face-to-face education [ F (5,1898) = 3.54, p < 0.01, GES = 0.003], online teaching [ F (5,1898) = 6.053, p < 0.001, GES = 0.004], online assessment [ F (5,1898) = 7.33, p < 0.001, GES = 0.006], online learning [ F (5,1898) = 8.686, p < 0.001, GES = 0.006], peer relationship [ F (5,1898) = 3.86, p < 0.01, GES.003], and self-efficacy for online learning [ F (5,1898) = 6.99, p < 0.001, GES = 0.005].

Regarding the main effect of OECD area, a significant effect for experience and for expectations was observed in the following four dimensions: Comparison to face-to-face education: experience [ F (5,1898) = 4.43, p < 0.01, GES.012] and the expectations [ F (5,1898) = 9.26, p < 0.001, GES.024]: online assessment: experience [ F (5,1898) = 4.71, p < 0.001, GES.012] and expectations [ F (5,1898) = 3.52, p < 0.01, GES.01]; online learning: experience [ F (5,1898) = 7.4, p < 0.001, GES.02] and expectations [ F (5,1898) = 9.57, p < 0.001, GES.03]; self-efficacy for online learning: experience [ F (5,1898) = 6.22, p < 0.001, GES.02] and expectations [ F (5,1898) = 5.52, p < 0.001, GES.01].

Regarding online teaching, a significant effect was observed in expectation [ F (5,1898) = 4.65, p < 0.001, GES.01], but not in experience ( p = 1). On the other hand, for peer relationship, a significant effect was shown for experience [ F (5,1898) = 3.67, p < 0.01, GES.01] but not for expectations ( p = 1).

We performed Tukey’s test to assess the differences between OECD areas in expectations and experience. Concerning expectations, the following dimensions presented significant differences (see Table 5 ). Comparison to face-to-face: Engineering and Technology - Agricultural Sciences p < 0.01, Engineering and Technology - Medical and Health Sciences p < 0.001, Engineering and Technology - Natural Sciences p < 0.05, Engineering and Technology - Social Sciences p < 0.001, and Engineering and Technology - Humanities p < 0.01. Online teaching: Engineering and Technology - Medical and Health Sciences p < 0.01 and Engineering and Technology - Social Sciences p < 0.001. Online assessment: Engineering and Technology - Medical and Health Sciences p < 0.05. Online learning: Engineering and Technology - Agricultural Sciences p < 0.01, Humanities - Medical and Health Sciences p < 0.01, Humanities - Natural Sciences p < 0.05, Engineering and Technology - Natural Sciences p < 0.01, Engineering and Technology - Social Sciences p < 0.001, and Engineering and Technology - Humanities p < 0.001. Self-efficacy for online learning: Engineering and Technology - Social Sciences p < 0.001 and Engineering and Technology - Humanities p < 0.01.

Table 5. Descriptive statistics on students’ expectations and experience during the ERT according to the disciplinary area.

In the case of experience, the dimensions that showed significant differences are listed below: Comparison to face-to-face education: Humanities - Agricultural Sciences p < 0.01, Humanities - Medical and Health Sciences p < 0.01, Humanities - Natural Sciences p < 0.05, Humanities - Social Sciences p < 0.05, and Engineering and Technology - Humanities p < 0.001. Online assessment: Medical and Health Sciences - Agricultural Sciences p < 0.001 and Social Sciences - Agricultural Sciences p < 0.05. Online learning: Medical and Health Sciences - Agricultural Sciences p < 0.001, Social Sciences - Agricultural Sciences p < 0.01, Engineering and Technology - Agricultural Sciences p < 0.01, Natural Sciences - Medical and Health Sciences p < 0.05 Humanities - Medical and Health Sciences p < 0.001, Humanities - Social Sciences p < 0.05, and Engineering and Technology - Humanities p < 0.05. Peer relationship: Humanities - Medical and Health Sciences p < 0.01 and Humanities - Social Sciences p < 0.05. Self-efficacy for online learning: Medical and Health Sciences - Agricultural Sciences p < 0.01, Social Sciences - Agricultural Sciences p < 0.01, Engineering and Technology - Agricultural Sciences p < 0.05, Humanities - Medical and Health Sciences p < 0.01, Humanities - Social Sciences p < 0.01, and Engineering and Technology - Humanities p < 0.01.

Finally, the simple main effect of the differences between expectations and experience for each dimension was analyzed, observing in some cases statistically significant effects for all six OECD areas, while in others only for one (see Table 5 ). The results reflected by the analysis are listed by dimension: Comparison to face-to-face education: Agricultural Sciences [ F (1,140) = 71.71, p < 0.001, GES = 0.16], Medical and Health Sciences [ F (1,415) = 227.33, p < 0.001, GES = 0.14], Natural Sciences [ F (1,311) = 93.81, p < 0.001, GES.08], Social Sciences [ F (1,508) = 247.639, p < 0.001, GES = 0.14], Humanities [ F (1,60) = 11.93, p < 0.01, GES = 0.06], and Engineering and Technology [ F (1,464) = 97.77, p < 0.001, GES = 0.06]. Online teaching: Agricultural Sciences [ F (1,140) = 8.14, p < 0.05, GES = 0.01], Medical and Health Sciences [ F (1,415) = 126, p < 0.001, GES = 0.07], Natural Sciences [ F (1,311) = 58.2, p < 0.001, GES.04], Social Sciences [ F (1,508) = 124, p < 0.001, GES = 0.06], Humanities [ F (1,60) = 23.8, p < 0.001, GES = 0.09], and Engineering and Technology [ F (1,464) = 51.6, p < 0.001, GES = 0.02].

The following differences in the dimension of online assessment between discipline areas were found: Medical and Health Sciences [ F (1,415) = 70.57, p < 0.001, GES = 0.05] and Social Sciences [ F (1,508) = 37.89, p < 0.001, GES = 0.02]. Online learning: Medical and Health Sciences [ F (1,415) = 86.1, p < 0.001, GES = 0.05], Natural Sciences [ F (1,311) = 26.4, p < 0.001, GES.02], Social Sciences [ F (1,508) = 131, p < 0.001, GES = 0.06], Humanities [ F (1,60) = 9.94, p < 0.05, GES = 0.5], and Engineering and Technology [ F (1,464) = 10.8, p < 0.01, GES = 0.006]. Peer relationship: Medical and Health Sciences [ F (1,415) = 42.1, p < 0.001, GES = 0.024], Social Sciences [ F (1,508) = 27, p < 0.001, GES = 0.014], and Engineering and Technology [ F (1,464) = 9.88, p < 0.05, GES = 0.005]. Self-efficacy for online learning: Social Sciences [ F (1,508) = 29.4, p < 0.001, GES = 0.02].

Figure 2 shows the size effect identified considering the OECD area. In Agricultural Sciences, we found a large-size effect in the dimension of comparison with face-to-face education and a small effect size in the dimensions of online learning, self-efficacy for online learning, online teaching, and the full scale. There were no effects detected in the rest of the dimensions. In Medical and Health Sciences, the analysis outcomes reflected a large-size effect in comparison with face-to-face education and a medium-size effect in the dimensions of online teaching and full scale. In addition, we found a small effect in the dimensions of peer relationship, online learning, and online assessment. In Natural Sciences, we found a medium-size effect in the size of comparison with face-to-face education and a small-size effect in online teaching, online learning, and full scale. No effects on the remaining dimensions were found. In the case of Social Sciences, we found a large-size effect for comparison with face-to-face education, a medium-size effect in the dimensions of online learning, online teaching, and the full scale, and a small-size effect in the rest of the dimensions. The Humanities area presented a medium-size effect in online teaching and comparison with face-to-face education dimensions and a small-size effect in online learning, peer relationship, online evaluation, and full scale. Finally, in Engineering and Technology, a medium-size effect in the dimension of comparison with face-to-face education and a small-size effect in the online teaching, online learning, peer relationship dimensions, and full scale were identified. In the rest of the dimensions, there were no effects detected.

Figure 2. Size effect regarding the change between expectations and experience according to the disciplinary area.

Due to the COVID-19 pandemic, the transition to ERT impacted students’ expectations and experiences during their professional training. This research aimed to analyze students’ expectations and experiences considering the gender and disciplinary area of the participants. Findings are analyzed and discussed in terms of the hypotheses raised in section “The Present Study.”

Differences Among University Students’ Expectations and Experiences During the Emergency Remote Teaching Produced by the COVID-19 Pandemic

Changes between students’ expectations and experiences during ERT were found. Students’ expectations at T1 about online education were negative. However, at the end of the academic period, students indicated having a positive experience in most studied dimensions. They only showed a negative experience regarding the relationship with their peers and the comparison with face-to-face.

Several studies during the pandemic point out the lack of confidence toward the different educational actors and online education opportunities. This mistrust is associated with a lack of knowledge of the modality and its advantages ( Villa et al., 2020 ) and little awareness of the available virtual educational tools ( Rahiem, 2020 ; Almomani et al., 2021 ). In addition, the unexpectedness of the transition was a challenge for teachers and students, generating a problematic, improvised, and intuitive confrontation ( Barbour et al., 2020 ; Hodges et al., 2020 ).

Students’ perception of the limited opportunities virtual classrooms and other technological tools provided them to interact and work collaboratively with peers is particularly noteworthy. Several reports emphasize the benefits of cooperative work versus a competitive or individualistic methodology in higher education. The former generates better learning and significant commitment and involvement in academic tasks ( León del Barco et al., 2017 ; Guerra Santana et al., 2019 ; Hamdan et al., 2021 ). Also, collaborative work is closely related to desired competencies in the profession’s exercise, an aspect that is not present in this study. In this context, the literature describes technological mediation in education to provide significant possibilities of simultaneous sociability, of connection between communities and people, subscription, and asynchronous communication that generates network effects that tend to accelerate individuals and group learning ( De Haro, 2010 ; Anthony et al., 2019 ). Therefore, it is crucial to understand why peer interaction during ERT was negatively perceived, especially considering that the LMS had the functionalities for such activities. We believe that it is partly a product of the little knowledge of these tools by both teachers and students.

The observation that students face online education with a high sense of self-efficacy, believing that they have the skills to respond to the learning challenges that this modality presents, could be explained by the lack of knowledge and experience, as well as underestimating the necessary skills. Consequently, students perceive a lower complexity than the real one, as described by the “Durning Kruger effect” ( Dunning, 2011 ). It is possible that by the regular use of technology, social media, phones, and computers, they initially self-perceived as more competent.

The perception of a better experience concerning the initial expectation suggests that the implementation of ERT, although not devoid of difficulties, responded to students’ needs. Hence, higher education institutions’ response and the teachers’ and students’ adaptation adequately provided a well-perceived learning environment. Furthermore, the above is consistent with other research during the pandemic that reported positive experiences by teachers and students in terms of having been able to face the educational process despite the adversities of the confinement and its urgency ( Sepulveda-Escobar and Morrison, 2020 ).

We can conclude that the educational community and higher education authorities have learned greatly during ERT. Therefore, it will be interesting to study how to translate these lessons into explicit guidelines and practices when returning to normality post-pandemic.

When evaluating changes in expectation and experience scores considering the sex of the participants, at the beginning of ERT, men and women presented similar levels of expectations about online education. However, experiences showed differences according to gender. Although both perceived the educational experience as positive, women gave higher values than men, in the dimension with lower punctuation in the experience compared with a face-to-face modality and peer relationship.

These results are consistent with the study reported by Almomani et al. (2021) , conducted during the COVID-19 pandemic, and reports that women students were more optimistic, satisfied, and committed to the online learning experience than men students during this period. Furthermore, a 62-country study on the impact of the pandemic on higher education ( Aristovnik et al., 2020 ) reports a minor negative impact of confinement on women students’ learning, adaptation, and relationship with the teachers. In this study, a similar result was obtained regarding the perception of online teaching. Women students presented a higher value of the teacher’s commitment to ERT. Women considered that instructors were available and attentive to their learning needs, complied with the course syllabus, and made good use of the available virtual classroom tools.

In another study on online university education in the context of COVID-19 ( Shahzad et al., 2021 ), the authors were able to identify differences between men and women regarding the perception of usefulness, ease, and satisfaction with the use of the learning management systems provided by the institution. This finding suggests that adaptation processes to university life in electronic learning environments may be different for men and women. Therefore, this information could be valuable for university authorities to strengthen and improve the university system support.

Differences in Students’ Expectations and Experiences by Disciplinary Area of Online Learning During Emergency Remote Teaching

Research on the effects of the COVID-19 pandemic in the context of higher education has identified significant challenges for implementing online education, such as inequality, funding, and ways to develop learning in general ( Aristovnik et al., 2020 ; Funk, 2021 ). In this context, it is essential to identify if these challenges and opportunities are specific to a particular disciplinary area or apply to the general community. Thus, differences during ERT between disciplinary areas were analyzed.

Differences in the expectations and experiences of university students in the six disciplinary areas classified according to their undergraduate programs were found. Unfortunately, there is little literature on the influence of the disciplinary area to which students’ undergraduate programs belong regarding experience with online education in ERT. Knowing about students’ experience in each disciplinary area will allow teachers and educational authorities to identify weaknesses and good practices that will otherwise not be detected to design and develop monitoring plans and improve the quality of online education in the future.

We found differences within expectations in the online teaching dimension for all disciplinary areas. On the other hand, Students from Engineering and Technology and Medical and Health Sciences areas reported higher experience scores in this dimension, which implies that these students felt more confident about the actions performed by their instructors. This result could be related to the use of technology by Engineering and Technology teachers and the teacher training in the medical education area, often advanced.

Despite the improvement between student expectations and experiences of the online assessment dimension, changes presented null (Agricultural Sciences, Natural Sciences, and Engineering and Technology) or small (Social Sciences, Humanities, and Medical and Health Sciences) size effect. The assessment processes continue to be an area of concern. Other reports support this statement. For example, Jordanian university students perceived that assessment during the pandemic allowed them to obtain higher grades than face-to-face assessments. Nonetheless, most students perceived that the evaluative processes were unfair and learned more minor than the quality reflected ( Almomani et al., 2021 ). Consistently, a study conducted with 8265 Chilean university students ( Lobos et al., 2022 ) reported that students perceived a bad experience regarding the assessment process during the pandemic. Again, researchers observed a greater expectation of obtaining a good grade rather than of achieving learning. As a result, students considered that they failed to achieve good quality training. Despite these findings, a study carried out in Chile indicates that students’ academic performance improved compared to the previous academic period ( Franco et al., 2021 ). Therefore, the guidelines and strategies used by teachers regarding assessment continue to be an essential element to consider in the design of quality online education.

An interesting finding is a large-size effect obtained in the differences between the scores of expectations and experience of students of Agricultural Sciences and Medical and Health Sciences, for the comparison with face-to-face education dimension. Further research is required to identify good practices teachers and students implement in undergraduate programs classified in these two OCDE discipline areas.

We believe that the differences in the results of the students’ expectations and experience according to the disciplinary area are due to the different challenges encountered in the adaptation of the courses (efficient ones). Accordingly, strategies used, for example, in Health Sciences, can be used in realistic training scenarios that relate to people (Social Sciences and Humanities). One of these strategies can be using remote standardized patients who have meetings with students through the Internet. These activities allow teachers and standardized students to have spaces for evaluation and feedback ( Langenau et al., 2014 ; Bączek et al., 2021 ). This technique could be adapted to other teaching contexts using work situations in the training of other professionals.

Concerning the dimension of self-efficacy for online learning, no significant changes in four of the six knowledge evaluated areas were observed. Agricultural Sciences and Social Sciences displayed differences with small-size effect. Thus, ERT did not increase students’ confidence beliefs toward taking classes in the online teaching modality.

Despite valuable information that has been obtained for this study, some limitations are identified. First, the results presented correspond to university students’ responses from a single educational institution, so the interventions of university authorities could bias expectations and subsequent experiences in the context of ERT. Second, it was not part of this study to evaluate access gaps and other student variables that could affect the results. Finally, variables associated with the teacher or course characteristics that may influence the outcomes could not be controlled. Therefore, the results aim to study changes between students’ expectations and experience in an exploratory way. Other studies must consider the assessment of student (e.g., difficulties in accessing online classes), professor (e.g., profession), or course (e.g., type, time commitment) variables that may affect undergraduate expectations and experiences.

Study Implications

In this research, we found that students’ experiences with online education during the ERT were more optimistic than their expectations at the beginning of the semester. For this reason, the results found, together with other sources of institutional information such as learning analytics and institutional indicators, will allow authorities and teachers to develop guidelines to promote quality online education. It is also possible that university authorities could consider these preferences to design and create online courses for their students ( Zapata-Cuervo et al., 2021 ).

The relationship with peers and professors is still considered a weak point of online education. This is a crucial aspect to be addressed by university professors. In the context of virtuality, professors need to maintain communication channels that allow them to provide students with timely feedback from online video tutorials or email guides after class ( Bao, 2020 ; Vladova et al., 2021b ). We identified statistically significant differences in the experiences of men and women. This represents an opportunity to investigate how the characteristics of each student improve academic performance and decrease the probability of dropping out of college.

We found differences in the students’ experiences according to the scientific areas. These results translate into a challenge to identify the strategies and actions that facilitated a positive experience to replicate them in similar formative contexts. Further, studies can be performed to identify good practices applied in general contexts and those appropriate for each discipline. Higher education institutions are expected to accompany teachers and students in the different scientific areas during the post-pandemic academic continuity. Exceptional support is scheduled in aspects such as planning and prioritization of practical classes, promoting a combined approach of virtual and face-to-face education ( Pham and Ho, 2020 ; Vladova et al., 2021b ).

Future research could assess how students’ variables (e.g., internet access, type of device used to study), courses’ factors (e.g., number of hours of dedication, learning goals, instructional design, type of materials, or shared resources), teachers’ aspects (e.g., technological acceptance, use of strategies, training) or the institution’s elements (e.g., promotion of teaching through technology, support for students and teachers, use of online learning platforms, technological campuses) impact the expectations and subsequent experience of students during the development of online courses., especially regarding strength and weaknesses according to discipline areas.

The findings of this work contribute to identifying dimensions and areas that require special attention to establish preventive and corrective actions by university authorities for the near future and propose the opportunity of further studying good practices of better-perceived experiences of discipline areas.

The students’ experiences during ERT due to the COVID-19 pandemic exceeded expectations. Students reported high expectations about their self-efficacy to cope with this new scenario, even though low expectations regarding peer relationships, online teaching, and comparison with face-to-face education were observed concerning the experience after the semester. Students indicated positive experiences with online learning and teaching. They felt that the professor provided adequate support in terms of education, instruction, and assessment. Negative experiences persisted regarding peer relationships and the overall experience compared to face-to-face teaching. Additionally, men and women presented similar expectations at the beginning of the semester regardless of their discipline, while women were more optimistic about educational experiences during ERT. Finally, concerning the disciplinary area, differences in most of the assessed dimensions were observed, representing an opportunity to study further and identify good practices in those dimensions and disciplines that presented positive perception and effect.

Data Availability Statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics Statement

The studies involving human participants were reviewed and approved by Institutional Ethics Committee of University of Concepción. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

KL and RC-R: conceptualization. KL, RC-R, and CB: methodology. JM-N: formal analysis and visualization. KL, RC-R, and AM-T: research and writing—preparing the original draft. AM-T, CB, and CF: resources, project management, and fundraising. JM-N and RC-R: data curation. CB and CF: writing—revising and editing. KL, CB, and CF: monitoring.

This research reported in this publication was supported by Unidad de Fortalecimiento Institucional of the Ministerio de Educación Chile, project InES 2018 UCO1808 Laboratorio de Innovación educativa basada en investigación para el fortalecimiento de los aprendizajes de ciencias básicas en la Universidad de Concepción.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords : COVID-19, higher education, university student, online teaching and learning, student self-efficacy

Citation: Lobos K, Cobo-Rendón R, Mella-Norambuena J, Maldonado-Trapp A, Fernández Branada C and Bruna Jofré C (2022) Expectations and Experiences With Online Education During the COVID-19 Pandemic in University Students. Front. Psychol. 12:815564. doi: 10.3389/fpsyg.2021.815564

Received: 15 November 2021; Accepted: 02 December 2021; Published: 05 January 2022.

Reviewed by:

Copyright © 2022 Lobos, Cobo-Rendón, Mella-Norambuena, Maldonado-Trapp, Fernández Branada and Bruna Jofré. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Carola Bruna Jofré, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Online learning is currently adopted by educational institutions worldwide to provide students with ongoing education during the COVID-19 pandemic. Even though online learning research has been advancing in uncovering student experiences in various settings (i.e., tertiary, adult, and professional education), very little progress has been achieved in understanding the experience of the K-12 student population, especially when narrowed down to different school-year segments (i.e., primary and secondary school students). This study explores how students at different stages of their K-12 education reacted to the mandatory full-time online learning during the COVID-19 pandemic. For this purpose, we conducted a province-wide survey study in which the online learning experience of 1,170,769 Chinese students was collected from the Guangdong Province of China. We performed cross-tabulation and Chi-square analysis to compare students’ online learning conditions, experiences, and expectations. Results from this survey study provide evidence that students’ online learning experiences are significantly different across school years. Foremost, policy implications were made to advise government authorises and schools on improving the delivery of online learning, and potential directions were identified for future research into K-12 online learning. Practitioner notes What is already known about this topic Online learning has been widely adopted during the COVID-19 pandemic to ensure the continuation of K-12 education. Student success in K-12 online education is substantially lower than in conventional schools. Students experienced various difficulties related to the delivery of online learning. What this paper adds Provide empirical evidence for the online learning experience of students in different school years. Identify the different needs of students in primary, middle, and high school. Identify the challenges of delivering online learning to students of different age. Implications for practice and/or policy Authority and schools need to provide sufficient technical support to students in online learning. The delivery of online learning needs to be customised for students in different school years.

• learner attitudes/perceptions
• primary education
• questionnaire
• secondary education

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T1 - Students’ experience of online learning during the COVID-19 pandemic

T2 - a province-wide survey study

AU - Yan, Lixiang

AU - Whitelock-Wainwright, Alexander

AU - Guan, Quanlong

AU - Wen, Gangxin

AU - Gašević, Dragan

AU - Chen, Guanliang

N1 - Funding Information: This work is supported by the National Natural Science Foundation of China (62077028, 61877029), the Science and Technology Planning Project of Guangdong (2020B0909030005, 2020B1212030003, 2020ZDZX3013, 2019B1515120010, 2018KTSCX016, 2019A050510024), the Science and Technology Planning Project of Guangzhou (201902010041), and the Fundamental Research Funds for the Central Universities (21617408, 21619404). Publisher Copyright: © 2021 British Educational Research Association Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/9

Y1 - 2021/9

N2 - Online learning is currently adopted by educational institutions worldwide to provide students with ongoing education during the COVID-19 pandemic. Even though online learning research has been advancing in uncovering student experiences in various settings (i.e., tertiary, adult, and professional education), very little progress has been achieved in understanding the experience of the K-12 student population, especially when narrowed down to different school-year segments (i.e., primary and secondary school students). This study explores how students at different stages of their K-12 education reacted to the mandatory full-time online learning during the COVID-19 pandemic. For this purpose, we conducted a province-wide survey study in which the online learning experience of 1,170,769 Chinese students was collected from the Guangdong Province of China. We performed cross-tabulation and Chi-square analysis to compare students’ online learning conditions, experiences, and expectations. Results from this survey study provide evidence that students’ online learning experiences are significantly different across school years. Foremost, policy implications were made to advise government authorises and schools on improving the delivery of online learning, and potential directions were identified for future research into K-12 online learning. Practitioner notes What is already known about this topic Online learning has been widely adopted during the COVID-19 pandemic to ensure the continuation of K-12 education. Student success in K-12 online education is substantially lower than in conventional schools. Students experienced various difficulties related to the delivery of online learning. What this paper adds Provide empirical evidence for the online learning experience of students in different school years. Identify the different needs of students in primary, middle, and high school. Identify the challenges of delivering online learning to students of different age. Implications for practice and/or policy Authority and schools need to provide sufficient technical support to students in online learning. The delivery of online learning needs to be customised for students in different school years.

AB - Online learning is currently adopted by educational institutions worldwide to provide students with ongoing education during the COVID-19 pandemic. Even though online learning research has been advancing in uncovering student experiences in various settings (i.e., tertiary, adult, and professional education), very little progress has been achieved in understanding the experience of the K-12 student population, especially when narrowed down to different school-year segments (i.e., primary and secondary school students). This study explores how students at different stages of their K-12 education reacted to the mandatory full-time online learning during the COVID-19 pandemic. For this purpose, we conducted a province-wide survey study in which the online learning experience of 1,170,769 Chinese students was collected from the Guangdong Province of China. We performed cross-tabulation and Chi-square analysis to compare students’ online learning conditions, experiences, and expectations. Results from this survey study provide evidence that students’ online learning experiences are significantly different across school years. Foremost, policy implications were made to advise government authorises and schools on improving the delivery of online learning, and potential directions were identified for future research into K-12 online learning. Practitioner notes What is already known about this topic Online learning has been widely adopted during the COVID-19 pandemic to ensure the continuation of K-12 education. Student success in K-12 online education is substantially lower than in conventional schools. Students experienced various difficulties related to the delivery of online learning. What this paper adds Provide empirical evidence for the online learning experience of students in different school years. Identify the different needs of students in primary, middle, and high school. Identify the challenges of delivering online learning to students of different age. Implications for practice and/or policy Authority and schools need to provide sufficient technical support to students in online learning. The delivery of online learning needs to be customised for students in different school years.

KW - e-learning

KW - learner attitudes/perceptions

KW - primary education

KW - questionnaire

KW - secondary education

UR - http://www.scopus.com/inward/record.url?scp=85105064273&partnerID=8YFLogxK

U2 - 10.1111/bjet.13102

DO - 10.1111/bjet.13102

M3 - Article

C2 - 34219755

AN - SCOPUS:85105064273

SN - 0007-1013

JO - British Journal of Educational Technology

JF - British Journal of Educational Technology

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Peer-reviewed

Research Article

The sudden transition to online learning: Teachers’ experiences of teaching during the COVID-19 pandemic

Contributed equally to this work with: Elham Goudarzi, Shirin Hasanvand

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing

Affiliation Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran

Roles Conceptualization, Methodology, Writing – original draft, Writing – review & editing

¶ ‡ SR and MA also contributed equally to this work.

Affiliation Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

• Elham Goudarzi, 
• Shirin Hasanvand, 
• Shahin Raoufi, 
• Mitra Amini

• Published: November 16, 2023
• https://doi.org/10.1371/journal.pone.0287520
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Introduction

The sudden transition from face-to-face teaching to virtual remote education and the need to implement it during COVID-19 initially posed specific challenges to educational institutions. Identifying and understanding teachers’ experiences pave the way for discovering and meeting educational needs. This study explored faculty members’ teaching experiences during the COVID-19 pandemic.

Materials and methods

The qualitative descriptive design via conventional content analysis was used. It was conducted from January 13, 2020, to May 10, 2022. In-depth interviews (online and in-person) of ten faculty members, three managers, and one staff from Lorestan University of Medical Sciences were conducted. They were purposefully selected with maximum variation. Simultaneously with data collection, analysis was performed using the approach Graneheim and Lundman proposed (2004). Lincoln and Goba’s criteria were used to obtain the study’s rigor.

Six categories emerged from the data: education in the shadow of the crisis, Challenges related to the teaching-learning process, Blurred boundaries between personal and professional lives, Positive consequences of e-learning, Trying to deal with the crisis, And dealing with the crisis.

Conclusions

Initially, teachers faced several challenges in the teaching-learning process and even in their personal life. However, with time, the actions of the teachers and the managers caused an increase in the quality of education. However, planning and foresight are needed in developing countries, including Iran, to appropriately face and optimally manage similar crises and move towards blended learning.

Citation: Goudarzi E, Hasanvand S, Raoufi S, Amini M (2023) The sudden transition to online learning: Teachers’ experiences of teaching during the COVID-19 pandemic. PLoS ONE 18(11): e0287520. https://doi.org/10.1371/journal.pone.0287520

Editor: Muhammad Arsyad Subu, School of Health Binawan: Universitas Binawan, INDONESIA

Received: September 7, 2022; Accepted: June 7, 2023; Published: November 16, 2023

Copyright: © 2023 Goudarzi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All interview files are available from figshare, https://doi.org/10.6084/m9.figshare.23599155.v1 .

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: F2F, Face-to-face; ICT, Information and communications technology

In late December 2019, a new subvariant of COVID-19 appeared in Wuhan, China, spreading rapidly worldwide [ 1 ]. The transmission rate of the virus and the subsequent pandemic were so significant that in the first month of 2020, the World Health Organization declared COVID-19 a state of emergency [ 2 ]. The first Iranian coronavirus case was officially announced in Qom on February 19, 2020 [ 3 ].

This global pandemic affected all areas of human life, including medical education [ 4 ], and disrupted face-to-face(F2F) learning worldwide. That is, F2F learning was suspended at medical universities, particularly in third-world countries, where the sudden change in educational planning was an inevitable consequence of the spread of the COVID-19 pandemic [ 5 ]. Insufficiency of resources and poor infrastructure severely damaged low-income countries [ 6 ]. In response to the closure of education, UNESCO recommended using distance education programs and related educational platforms by educational institutes to benefit from distance education and minimize any disruption in the learning-teaching process [ 7 ].

Distance education is a planned type of education where teaching and learning occur in different environments [ 8 ]. In recent years, the development of distance education has significantly contributed to promoting learning-teaching quality and expanding educational justice [ 9 ]. Certain advantages and disadvantages can be attributed to distance education. Its benefits include the feasibility of teaching regardless of time and place, cost-effectiveness [ 10 ], non-necessity of physical attendance [ 11 ], the existence of a variety of choices [ 12 ], saving time [ 10 ], studying simultaneously with working [ 12 ], and the development of participatory and independent types of learning [ 13 ]. Moreover, high probability of lack of concentration, the need for complex technology [ 12 ], reduced social interactions [ 14 ], unstable internet connection [ 13 ], the inability to comprehend and interpret students’ facial expressions, and inability to hold practical and laboratory meetings are also among the disadvantages of distance education [ 6 ].

One important change after the campus closure was the transition from face-to-face universities to virtual universities to prevent the spread of COVID-19 [ 15 ]. In countries such as Italy, Spain, China, the USA, and even Brazil, distance learning has been widely used during the COVID-19 pandemic, particularly in medical education [ 16 ]. The use of distance education commenced in Iran with the emergence of the coronavirus. Although distance education was initially presented to students irregularly using social media, Iranian universities gradually adopted a systematic version of distance education using a centralized system of learning management according to the instructions issued by educational authorities. However, this system did not turn out to be an ideal one. Students and faculty members faced challenges such as slow internet speed, limited cyberspace to upload e-content, and reduced teacher-student interactions [ 17 ].

As was indicated in a study on the challenges encountered by faculty concerning distance education, a flawed organizational culture or the lack of a culture of working with e-learning tools such as computers, and the failure to train faculty members about how to operate these tools were also among the essential barriers to efficient distance education. Furthermore, lack of equipment, slow internet speed, lack of sufficient cyberspace for uploading educational materials, being time-consuming and costly, and ignoring the intellectual property rights, such as unauthorized copying of the content and violation of copyright principles in the cyberlearning environment were other challenges raised by the participants [ 13 ]. In another study that focused on the experiences of teachers about distance education during the COVID-19 pandemic, many students expressed their concerns about losing contact with their peers, separation from academic communities, hardware and software inconveniences, lack of a quiet environment, and a separate room at home to attend virtual classes, lack of access to libraries and resources, and deprivation from clinical and laboratory activities. Faculty members complained about increased responsibility and workload and emphasized the necessity of having access to comprehensive mental health services that should be provided for both themselves and students [ 18 ]. In Marek et al. (2021) study, faculty who converted classes to remove learning during COVID-19 experienced much higher workloads and tension than in F2F classes [ 19 ].

A systematic review showed that fewer studies had been conducted in remote emergency teaching or e-learning during the Covid-19 pandemic [ 15 ]. Few studies, especially quantitative, have been conducted in Iran, and faculty members’ experiences have yet to be investigated. This issue is a significant gap because it cannot be supposed that these experiences are similar to those in different cultural and social contexts. Thus, considering the emergence of the COVID-19 pandemic and its adverse effects on education worldwide, the disruption of teaching-learning processes in universities and teachers, and students’ unpreparedness, it seems necessary to investigate teachers’ experiences and deal with distance education. Such an investigation can contribute to the identification of the facilitators of and impediments to distance education if the COVID-19 pandemic persists or similar crises emerge. Thus, this study explored the teachers’ teaching experiences during the COVID-19 pandemic.

This qualitative study used a conventional content analysis from January 13, 2020, to May 10, 2022, to describe the professor’s teaching experiences during the COVID-19 pandemic. Content analysis is a study method for forming replicable and proper inferences from data to their context. It provides knowledge, new insights, a manifestation of facts, and a practical action guide. The aim is to acquire a condensed and comprehensive description of the phenomenon, and the result of the analysis is concepts or categories depicting the phenomenon. Conventional content analysis is used when there are no previous studies or research literature about the phenomenon, or it needs to be more cohesive. Researchers do not utilize predetermined categories. Rather, it lets categories and category labels flow from the data [ 20 ].

Participants and data collection

Participants included ten faculty members, three administrators, and one staff of the Department of Education affiliated with Lorestan University of Medical Sciences (Western Iran). Participants were selected by purposeful and maximum variation sampling(gender, marital status, work experience, having experience in e-learning, specialty). Inclusion criteria were willingness to participate in the study and share their experiences.

The data were gathered through unstructured in-depth F2F or electronic interviews by the first author under the supervision of the second author. Since the second author was a faculty, the first author took responsibility for the interviews. However, the second author supervised the interviews because of his experience in qualitative research.

Due to the absence of some faculty members in the university, particularly at the beginning of the study, the interviews were conducted mainly electronically using either telephone or Adobe Connect video-conferencing software and later in person under health protocols. Also, F2F interviews were conducted with the participants’ consent at their workplaces.

The interviews began with questions: "Could you please let us know about your teaching experiences since the emergence of the COVID-19 pandemic? What challenges did you face? How did you manage your class?" The participants were further investigated by answering probing questions such as "Could you explain more?" and "Could you please give an example?". The interviews were done individually and lasted an average of 20 to 50 minutes.

The data were recorded on a digital audio recorder. Field observations complemented the interviews. Sampling continued until data saturation when the collected data confirmed the previous data. Data saturation occurred after the 12th interview. To make sure two more interviews were conducted. Overall, 14 interviews were conducted with 14 participants. All the participants volunteered to participate in the study, and no one refused. The time and the place of the interviews (F2F) were arranged with the participants.

Data analysis

The data analysis was conducted simultaneously by collecting data using the approach proposed by Granehim and Lundman(2004) with the following phases: 1) immediate transcription of interviews, 2) listening to them to obtain a general perception, 3) identification of significant parts and initial codes(the label of a meaning unit), 4) classification of similar initial codes in broader categories (creating categories), and 5) determination of the hidden content in the data [ 21 ]. Hence, after listening to the interviews, they were transcribed and read several times. In the next phase, the significant units were identified and coded. We consider a meaning unit as words, sentences, or paragraphs containing dimensions about each other through their content and context. The condensed meaning units were abstracted and labeled by a code. Subsequently, the codes were classified using a constant comparison technique, identifying differences and similarities, and subcategories were identified. Finally, the findings were compared, and categories were determined. Data analysis was carried out using the MAXQDA 10 software.

Ethics approval and the consent to participate.

The present study was conducted under the Declaration of Helsinki. The code of ethics was also obtained from the Ethical Committee of the Vice-Chancellery for Research and Technology affiliated with Lorestan University of Medical Sciences (Code: I.R.LUMS.REC.1399.242). Providing the necessary explanations about the research objectives, we obtained written informed consent from all the participants. The subjects were allowed to record audio. The first author kept the recorded files in a locked file to ensure the security of the data.

Guba and Lincoln’s (1994) criteria, i.e., credibility, dependability, confirmability, and transferability, were used to ensure the trustworthiness of the data. Participants with experience in the studied phenomenon were selected to increase the credibility of the data. The researcher’s prolonged engagement and contact with participants (more than one year) were also considered. Moreover, more than one of the authors (the first and second authors) participated in the data analysis. Member-checking was also used. An attempt was made to improve data transferability by describing the participants’ culture, context, and characteristics. The audit trail approach and maximum variation were used to ensure transferability. People with an experience in qualitative research (Outside researchers) evaluated the data analysis process to ensure the findings were consistent.

The intercoder rater is a scale of the agreement between multiple coders about how similar data should be coded [ 22 ]. An inter-coder reliability analysis using Cohen’s Kappa statistic was conducted to determine consistency between coders. Cohen’s Kappa coefficient of agreement s was 0.871.

Fourteen participants participated in this study. Table 1 provides information about the participants.

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https://doi.org/10.1371/journal.pone.0287520.t001

The qualitative interviews extracted 1215 initial codes, 28 subcategories, and six main categories. Table 2 presents subcategories and categories extracted from the interviews.

https://doi.org/10.1371/journal.pone.0287520.t002

Category 1: Education in the shadow of the crisis

University closures necessitated the pursuit of distance education. Nevertheless, many faculty members and administrators thought they faced a temporary crisis. Thus, no significant measure was taken at the onset of the crisis. According to one of the participants, upon the emergence of the COVID-19 pandemic, it was maintained that the disease would disappear soon. Hence, no intense action was taken in the first month.

1.1. The idea of being temporary.

Many teachers thought the crisis was temporary, so no particular action was taken early. One of the participants said: ”The disease would disappear soon , so no special action was taken in the first month of the disease”(P1) .

1.2. Being unpredictable and uncertainty.

During this period, the teaching-learning process fluctuated, and faculty members were undecided. Moreover, some hospital wards were closed due to a lack of patients, decreased days of student internships, and a reduced variety of hospital cases. One of the participants said: "In the first months of the crisis , we underwent extremely unpleasant experiences and did not know what to do in that situation . On the one hand , we were worried about the students . On the other hand , we had to reduce , for example , the number of internship days . Furthermore , there were almost no patients in the wards because people were full of fear and panic" (P2) .

1.3. Educational confusion.

The sudden transition in education from F2F to distance education confused teaching and reduced the quality of teaching. As one of the participants mentioned: "Timely preparing all the educational content for students was another challenge for us . Inevitably , this preparation was prone to delay . I can assert that 99% of the faculty members could not provide the educational content for distance education without delay in the first semester following the COVID-19 pandemic because all the courses were offered to students within the distance education framework" (p9) .

1.4. Life insecurity.

Despite the widespread use of distance education in universities, some institutions face particular challenges. Medical students need to take internships in clinical settings. The fear of contracting the disease and the insecurity of life left many educators and administrators with moral and professional challenges. Some clinical faculty members were dealing with the threats posed by COVID-19 in hospitals. Moreover, concerns about the spread of the disease adversely affected the quality and quantity of clinical sessions. As one of the faculty members said:

" in this period , the stress and tension were caused by the COVID-19 pandemic rather than teaching . I feel stressed out every time I attend class , but this time the stress was caused by the question of death or survival . " (p8)

Another said:

"We were exposed to a death threat when we attended the hospital to teach students in this environment . " Every day there were several confirmed COVID-19 cases in the hospital . I remember I contracted the coronavirus the day after examining a confirmed COVID-19 patient (P13) .

1.5. Teachers’ concerns about the failure to learn from students.

Some faculty members expressed concerns about students’ failure to learn practical courses and the subsequent weakening of students’ fundamental and practical knowledge and skills. One of the Midwifery faculty members stated: "I was supposed to teach a 7th-semester student who has never been present in either a cesarean surgery or natural childbirth event in the hospital . This student will graduate in the following semester . I wonder if she can perform her duties as a hospital staff (p12) .

Category 2: Challenges related to the teaching-learning process

There were several challenges regarding interpersonal interactions, assessment, network connection, and educational materials development in the teaching-learning process.

2.1. Decreased quality of interpersonal interactions.

The lack of inclusive participation and direct interactions between teachers and students adversely affected the quality of education. A female faculty member said:

"Interactions , eye contact , and in any case , some emotional-psychological factors between teachers and students are eliminated in distance education" (P4) . "The main problem we had with e-Learning was that we were not in touch with students , and they did not have the opportunity to visit us " (P8) .

2.2. Authentication challenge.

Classroom management is complex in online classes due to the physical absence of teachers, particularly in large classes.

"Coordination of the class time with students was one of the problems I encountered in distance education . Normally , students are expected to attend the class on time following our announcement of the class time . However , some students failed to attend the class on time" (p5) . "It is difficult to coordinate all students in a virtual classroom" (p9) . Another faculty member stated that "it is hard to control a class with a large population" (p12) .

One of the significant concerns of faculty members was the problem of student identification and teachers’ uncertainty about the presence of students in online classes. Some faculty members could not ensure the students’ full-time presence in online classes: "I do not know if the person taking the test is the student or someone else . Thus , identity verification is a major problem . " (p1)

2.3. Assessment challenges.

One of the challenges for faculty members during this period was the limitation in preparing the test questions. They had to prepare new questions at the end of every semester due to the possibility of question leaks: "Students had the chance to take screenshots of questions , which means that the questions could not be reused , and the faculty members had to redesign the questions at the end of every semester . " (p1)

Many faculty members considered students’ copying of one anothers’ homework, cheating, and negligence of ethical principles in preparing their assignments among the disadvantages of distance education: "Concerning the disadvantages of distance education , I can safely assert that the most notable shortcoming of this type of education was the inaccurate assessment of students’ knowledge . It is unclear who is taking the test . Is it the student , a friend , or someone who has been paid to take the test ? " (p1) .

Obtaining unrealistic grades by cheating on each other and copying the answers to questions from the internet has led to a decline in the quality of education and the impossibility of distinguishing between intelligent and weak students. As one of the faculty members mentioned, "A student with the overall average of grades that ranged from 14–15 has now the overall average of 19 ! Does it mean that all of them have become geniuses ? What has happened ? They are indeed cheating ! " (p3) .

2.4. Depreciation of teachers’ equipment.

One of the requirements of distance education is to provide suitable hardware equipment. Some faculty members complained about the depreciation of equipment and personal computers due to frequent transportation to the university and their continuous use because of the lack of a proper hardware system to hold classes. "The teachers had to use their equipment . Many of us did not have access to the necessary audio-visual equipment at the university" (p2) .

2.5. Teachers’ low skills and knowledge of ICT.

Due to the critical situation, teachers were forced to use distance education, while many were unfamiliar with virtual education technologies. This issue caused confusion and confusion in their minds. One of the professors said:

“Professors have a problem with producing content , and how to upload it ? ” What exactly is this learning management system ? Many professors do not know the system either” (p3) .

One o f the managers also confirmed this issue and said:

“In the beginning , we had many problems because maybe 99% of our users were people who had not used the learning management system before this space and were not familiar with it . ” (p11)

2.6. Teachers’ resistance to a sudden change in the teaching strategy.

Some faculty members resisted this abrupt change in the teaching strategy: "At the beginning of using Navid website (our native learning management system) , initially our colleagues and then students resisted the use of this system" (p2) .

Another faculty member stated that;

"The use of distance education had already commenced before the emergence of the COVID-19 pandemic , but most faculty members refused to teach within the framework prepared for distance education . They did not want to trouble themselves . Since they did not use the Navid LMS before the emergence of the crisis caused by the coronavirus , they needed help to cope with it during the crisis . They do not perform their tasks adequately . Every week , they were called to be reminded of their tasks (p3) .

2.7. Network connection issues.

The preparation of adequate infrastructure and the equipment required for communication and internet connection is highly significant in the development of distance education.

"The lack of a high-speed internet connection was a significant problem adversely affecting this type of education . Another faculty member complained about the inconveniencies related to uploading the educational content , which was time-consuming that sometimes took several hours" (p7) . "Moreover , low-speed internet at the university forced us to participate in online classes at home , where we had access to high-speed internet" (p4) .

2.8. Insufficient support.

Many faculty members complained about the lack of full-time support, a fundamental task of I.T. men. Hence, technical problems that were not resolved aggravated the situation: "They did not respond to our hardware and software questions . " (p6) .

2.9. The challenges in developing e-content.

Faculty members were not skillful in ICDL. Thus, they were not familiar with content development technologies. The ultimate consequence was the production of non-standard content. Moreover, the lack of a quiet environment at home to record audio made it difficult for them to produce the content. One of the faculty members with previous experience in e-learning said: "The teachers experience problems producing and uploading the content" (p3) .

A male faculty member who had twins said: " I need a quiet room to produce the content at home , but I have twins who are almost one year old . The loud sound of their crying and playing was an obstacle to content production" (p12).

2.10. Weaknesses in the implementation of practice-oriented training.

Practical courses are highly significant in medical universities. However, due to the closure of universities, only theoretical courses were offered to students. Consequently, laboratory and clinical courses were not offered regularly. Furthermore, no standard simulators or special clinical and laboratory training tools existed. "The difficulties with distance education aggravate fields of studies with many practical units , such as nursing , medical operating room technology , laboratory sciences , and medicine . Students’ attendance in class is necessary for several of the courses of these fields , and the use of simulators cannot efficiently meet the requirements of practical courses" (P3) .

2.11. Students and teachers’ misuse of distance education.

From the faculty members’ perspective, students refused to attend online classes on time, participate attentively in the classes, study the electronic content on time, and do homework under various pretexts during the COVID-19 pandemic.

"Students prefer to have a classmate receive educational materials from their teachers to share them with them in the groups they create on social media networks such as WhatsApp and Telegram" (p2) . "Skyroom (a Persian version of Adobe Connect) could be an efficient software for distance teaching , but most students found different pretexts to justify their absence in online classes . They would claim that the teacher’s voice is not clear , the video is frequently interrupted , our internet connection or the power has failed" (p8) .

Unfortunately, there was no reliable monitoring system to evaluate faculty members’ performance in the teaching-learning process, and this disadvantage caused several irregularities.

"Some faculty members do not take e-learning seriously . The teacher , for instance , uploads a file while there is no content in the uploaded file" (p3) . Some faculty members uploaded only three files for a two-credit course , while they were expected to prepare and upload at least 12 files (p6) .

3. Blurred boundaries between personal and professional lives

According to the faculty, e-learning was time-consuming. It increased their workloads and interfered with their professional and personal roles. The faculty members said e-content development during the COVID-19 pandemic was time-consuming.

3.1. Time-consuming distance education.

content development during the COVID-19 pandemic was time-consuming and required time and energy, especially since the professors were not skilled enough. Some problems most professors mentioned were teacher involvement during non-office hours, time-consuming voicing of files, or re-voicing content due to hoarseness during voicing. “If normally , I would check the slide a quarter of an hour before I go to class and leave , but not now ! I would have to spend several hours now، Files and audio , that one and a half or two hours of my session now took four times that time” (p2)

Another English teacher said, "To prepare the file , I had a series of problems . I had to write the whole text of the book in English or scan it and convert it into a file in PowerPointFor each lesson , for example , I prepared 20 slides , each of which I had to write six to seven English lines; the interval when I was recording the sound was very difficult , meaning that I could , for example , mispronounce the word myself" (p12)

One of the professors of epidemiology said: "For example , I used to voice the complications of Quid on the files , and because the disease was unknown , I also talked about COVID , and then when we went forward , we saw that the risk factors for this disease had changed . The rate of change has changed , then the conversations have become old , and , for example , the prevention method has changed , and now we have to do this new-sounding file again . It was not that we had to leave the same file every semester; we had to update these files every time , which was time-consuming” (p9) .

3.2. Increase workload.

With the virtualization at once, the professors’ workload increased significantly, development of standard content Increased the workload of the university’s e-learning department; responding to faculty problems was one of the issues that multiplied the workload of faculty and staff.

One of the professors in charge of developing internship programs said:

“It used to be that we had to put a program on the site from the beginning of the semester , but I can tell you that we wrote maybe 7 to 8 programs in the previous semester , and that put a lot of my work and that of my co-worker into the realm of bed and education” . (p2) " As I said , we used to see students in class , but now we have to be online 24 hours and constantly answering to students , which caused us to devote much family time to this work " (p6) .

3.3. Interference between work and nonwork roles and family restrictions.

The full-time presence of teachers at home and the introduction of virtual education led to role interference, resulting in changes in expectations and dissatisfaction among family members. Many professors confirmed this issue. This role interference was especially evident for teachers with younger children. " Now our work problems have been brought to the family , both child and spouse . My child has been arguing with me many times in the virtual classroom because I said I am the head of the virtual classroom . He does not know his childish needs , But I have to be responsible because my work environment is one with home , which has diminished our mother’s and my wife’s roles" (p6) .

On the other hand, gathering family members at home due to corona restrictions caused noise and congestion in the home environment. They led to a lack of focus and increased psychological pressure on teachers to produce content and hold online classes. This issue led to restrictions on family members, such as forcing children to remain silent. Consider deleting some family plans.

One of the teachers who had a young child said,

“I will never forgive myself . I beat my children ،Because it happened in the middle of the sound; they suddenly entered the room and argued or , for example , asked a question " (p7) “When one’s work environment becomes one with the living environment , many restrictions are created for the family . For example , I had to silence the whole family during class hours،The child should not watch the movie while the house was a space for rest , but because I had a virtual class or recorded content , for example , the noise of the environment was very annoying , and it made me put some restrictions on my family” (p6) “It was challenging , the family was distraught , that is , I had to tell the family to go to that room , and I would have the file in another room” (p12) .

4. Positive consequences of e-learning

4.1. flexibility..

Despite the difficulties experienced and explained by the majority of the teachers, a few of them mentioned the benefits of e-learning. Flexibility is one of the features of e-learning. More precisely, the implementation of distance education does not depend on time and place. Moreover, it does not require a particular physical space shared by students and the teacher. Confirming the issue of flexibility in distance education, one of the faculty members said:

"The most important advantage of distance education is that we can save time because many students who normally reside in dormitories no longer have to travel long distances to attend the campus . We can coordinate and hold classes at any time" (p5) "A remarkable advantage of e-learning is the chance peculiar to students employed in an organization . Many of our students who were employees during this period could benefit from e-learning and keep their jobs" (p7) .

Moreover, although the faculty members encountered several challenges faced by distance education during the COVID-19 pandemic, this crisis and the consequent abrupt alteration in the education system forced the teachers who were negligent of e-learning to turn to this type of education, and to some extent performs their tasks willingly. One of the teachers confirmed the positive impact of the compulsory experience of distance education: "Distance education had positive effects on us . That is , we would never be involved in distance education if the COVID-19 pandemic did not force us to carry out our tasks at home within the framework of e-learning . E-learning turned out to be highly beneficial . We learned how to use software" (p2) .

4.2. Facilitation of educational processes.

"If the COVID-19 crisis had not emerged , it might have taken ten years to reach this point , and we would have had to carry out a seven-year mission in four to five months . Thus , in this respect , the COVID-19 pandemic might have been beneficial in this respect" (p7) . "We had to learn how to use certain software , and I think it was a great chance for us" . (p4)

4.3. Cost reduction.

Faculty members’ experiences revealed that virtualization of education reduces the costs of holding workshops and conferences and provides students with accommodation and food. As one of the administrators mentioned in this regard: "University expenses have significantly decreased . No longer was any fund allocated to routine services such as transportation , dormitory maintenance , and cooking , as well as serving food for students due to the closure following the aggravation of the crisis . Only a few students were still in dormitories to pursue their internship" (p5) .

5. Trying to deal with the crisis

5.1. using social media as a learning tool..

Faculty members were unfamiliar with the university’s learning management system at the onset of the coronavirus crisis. Hence, they used social media messaging applications to continue their teaching task and prevent interruption. One educational administrator stated, "Due to the unpredictability of the continuation of the COVID-19 pandemic , it was first decided that the faculty members revise their PowerPoint files for a few sessions and send them to students via social media messaging applications or emails" (p1) .

5.2. Targeted empowerment of faculty members.

After familiarizing, teachers and students with the learning management system, several workshops and short-term courses were held to empower them. One of the teachers who were not competent in producing e-content said: "Although the preparation of standard educational content by faculty members was an educational challenge , the difficulties and problems of content preparation decreased following the participation of the faculty members in the training workshops held by the Education Development Center (EDC) of the university" (p5) .

5.3. Strategies for classroom management.

Faculty members used various tricks to improve their class management following the alleviation of the COVID-19 crisis. They emphasized dividing the students in crowded classes into two groups, giving two distinct types of tests, setting periods for homework, giving appropriate and case-based questions, and using new teaching methods such as an online flipped classroom.

"I tell the students that although the Navid LMS has a forum , Skyroom classes are live . Moreover , Skyroom provides us with a forum too . The cameras are connected within the framework of Skyroom , and we can see each other and share laptop screens" (p10) . "I tried to design the questions so that they would not cheat . I would give them cases so that only those who study the sources pass the exam . I gave exams with conceptual questions" (p14) .

5.4. Strategies for assessment management.

To have a realistic and authentic assessment, some faculty members asserted that learners’ assessment should not be limited to summative assessment. Furthermore, formative assessments and various assignments during the semester should be considered. "I think student assessment should be carried out primarily during the semester and with the assignments they are given" (p1) .

6. Beyond dealing with the crisis

According to the faculty members and administrators, this crisis was beneficial in preparing higher education institutions for future crises. The COVID-19 pandemic foregrounded the significance of e-learning in educational institutions.

6.1. Readiness to respond to future crises.

Although the COVID-19 pandemic imposed tremendous pressure on all aspects of society, including public health, specific potentials were gradually utilized to alleviate the coronavirus crisis. Consequently, the crisis was turned into appropriate educational opportunities. Several advantages can be attributed to the crisis management procedure during the COVID-19 pandemic. The pervasiveness of virtual education, the familiarity of teachers with various educational software, their capability to respond to future crises, and the development of specific strategies by the faculty members to guarantee the continuity of education by teachers are significant advantages. One of the teachers who were not familiar with educational software said: "Virtual education was good in this era because it introduced us to different software anyway" (p2) . "

6.2. Search and discover solutions to strengthen the continuity of virtual education.

Following the improvement in faculty members’ capabilities in e-learning, their readiness to respond to future corona-like crises was also improved. If similar problems arise and e-learning becomes necessary, they will no longer have the concerns of previous crises. They can be more prepared to deal with and manage it.

"The experience of e-learning during the COVID - 19 pandemic contributed to our readiness to respond to similar crises in the future . " (p7) . "I started an e-learning course to prepare myself for similar crises because I thought it would not be our last experience in the coming years , and other similar issues are likely to occur in the future . If crises like coronavirus arise , we will hold classes virtually " (P2) .

With the emergence of the COVID-19 pandemic, higher education suffered a great shock and, ultimately, an unexpected and unpredictable crisis worldwide, particularly in Iran. As a result, educational institutions were not ready to face this crisis, and the inevitable consequence was the emergence of education challenges.

In this study, the faculty members stated that they were initially unfamiliar with e-learning. This lack of familiarity and unpreparedness led to stress and mental confusion. Shenoy et al. (2020) and Aliyyah et al. (2020) reported similar instructors’ experiences in their studies. The instructors who participated in these studies stated that they also were exposed to mental confusion at the beginning of the virtualization of education. However, they reported their relative satisfaction over time [ 23 , 24 ].

On the other hand, the faculty members expressed concerns about the students’ learning disabilities and the challenges related to the practical course. This issue was reported in the study by Salmani (2021) in a category entitled Students’ superficial learning as a Challenge in E-learning in the COVID-19 Pandemic [ 25 ]. In another study, the low quality of virtual education compared to F2F teaching and students’ superficial learning have been dealt with [ 26 ].

Other challenges from instructors’ perspectives were raised consistent with previous studies. One of the primary challenges of e-learning based on the faculty members’ experiences was their resistance to e-learning. Some faculty members did not believe in the efficacy of e-learning, which was consistent with the findings of the study conducted by Mohi et al. (2020) [ 27 ]. One of the reasons for faculty members’ resistance to e-learning is that they are accustomed to traditional teaching. For years, they have preferred conventional teaching methods negligent of diversification or development of new methods of e-learning [ 28 ]. If the benefits of e-learning are emphasized, and faculty members become aware of this issue, as noted in the study by Mishra et al. (2021), they will be more motivated to teach [ 6 ].

The lack of high-speed internet bandwidth for preparing and uploading educational content led to faculty members’ dissatisfaction with this type of teaching. Moreover, the lack of standard infrastructure and suitable hardware and software equipment were among the challenges encountered by other faculty members in this period. Using personal equipment led to the depreciation and multiple repairs of these devices. Rezaei et al. conducted a study reporting the challenges encountered by faculty members (2020). They stated that most teachers’ cell phones were obsolete, and their laptops were primarily outdated [ 29 ]. The lack of suitable infrastructure was reported in many studies, particularly in developing countries [ 30 , 31 ]. Teachers called for the support of experienced staff and experts concerning educational technologies and e-content production. Consistent with the present study, Dawn (2019) has pointed out the significance of teachers’ familiarity with e-learning technologies during the COVID-19 pandemic [ 32 ]. Hence, the availability of a technical support team is essential for successfully developing an e-learning system and resolving the faculty members’ problems. Investing in human resources and their training is a significant issue for the development of e-learning [ 31 ].

An essential part of the data indicated challenges related to the suspension practical and laboratory courses. In their study, Sam et al. (2020) also mentioned suspending clinical education activities to reduce disease transmission and decrease patient hospitalization [ 32 ]. This issue is fundamental. Many students may miss the opportunity to acquire communication and technical skills due to reduced internship periods, academic and laboratory activities, and the lack of standard tools for practical courses. Onyema et al. (2020) also cite the limited access to physical and laboratory facilities as an adverse effect of e-learning [ 26 ].

According to many teachers, the reduction in interpersonal interactions, the lack of F2F interactions, and the consequent delay in providing the students with feedback caused the faculty members and students not to know each other’s abilities. In a similar study, the lack of proper communication between students and faculty members and their failure to provide their students with appropriate feedback was mentioned as teaching challenges during the COVID-19 pandemic [ 33 ]. According to De Oliveira et al. (2020), feedback difficulty in identifying students’ strengths and weaknesses is sometimes due to the lack of modern communication between teacher and student [ 34 ].

Another study referred to the lack of efficient interactions in virtual education as the main negative feature of this type of education [ 35 ]. Thus, interactions between teachers and students and timely feedback are central to the success of the educational process.

Student identification was one of the challenges stated by faculty members to be reported in the present study. Similarly, Agarwal MS et al. (2020) reported that many faculty members were uncertain about students’ presence in the virtual classroom. The lack of accurate authentication tools was an obstacle to ensuring students’ presence in virtual classrooms [ 36 ], which was consistent with the findings of this study. In the study by Lau et al. (2020), a defect in the evaluation of students by faculty members due to the lack of proper assessment tools was referred to as one of the most critical challenges of e-learning [ 37 ]. Other studies confirm that teachers can not guarantee that students are not cheating in electronic exams.

Moreover, it is impossible to ensure that the participant in the test is a student or someone else. Thus, the lack of proper assessment tools is one of the main problems of e-learning [ 28 ]. Virtualization of education also led to various kinds of abuse by some students and faculty members, consistent with the study by Agarwal et al. (2020) [ 36 ].

During this period, after overcoming the initial challenges of the COVID-19 crisis, the teachers’ experience in the field of virtual education and how to manage virtual classes increased, which led to the use of a variety of strategies for optimal classroom management and electronic assessment, including variation in teaching methods, keeping the class enjoyable to students, student participation in discussions, randomization of questions, and giving conceptual and challenging questions. These strategies contribute to motivation enhancement in students to participate in virtual classes [ 24 ]. Moreover, being satisfied with a single assessment method reduces the validity of the assessment, and it is essential to use multiple assessment methods instead of summative assessment [ 35 ].

One of the most critical points related to teachers’ experiences during this period was performing the teaching-learning task at home and blurring the boundaries between their personal and professional lives, which is consistent with Abedini et al. (2020) [ 38 ]. The home environment is not designed for academic activities. Hence, family members’ involvement at home causes overlapping roles and dissatisfaction. A similar study indicated that with the full-time presence of teachers at home, family members’ perceptions of the role of teachers changed. They expected teachers to perform the assigned functions alongside family members [ 39 ]. Teachers’ workload was increased according to teachers’ experiences, which was also confirmed in the study [ 40 , 41 ].

Despite the many disadvantages and challenges of virtual education, particularly during the COVID-19 pandemic, some advantages can be attributed to this educational approach, such as independence about time and place, reduced costs, the possibility of studying and working simultaneously and saving time. These advantages were reported in the study by Mukherjee et al. (2021) [ 39 ]. Alterations in the attitude of teachers toward e-learning and adaptation to it was one of the main advantages and the main factor facilitating the educational process during the COVID-19 pandemic. Taghizadeh et al. asserted that the crisis was a blessing for faculty members. The teachers who were not interested in e-learning became familiar with various educational software [ 37 ].

Furthermore, the experience gained by faculty members has enabled them to deal with similar crises in the future. Vershitskaya et al. (2020) showed that following the onset of the COVID-19 pandemic, faculty members maintained that e-learning should not be ignored when the COVID-19 crisis is over. Instead, they asserted that it should be used as a supplement to F2F education [ 41 ].

Managers’ attitudes were also considered in addition to the perspectives of faculty members in the present study, which could be considered a strength. However, the lack of students’ opinions concerning e-learning was one of the limitations of this study. The researchers who conducted the present study are teachers. Thus, their assumptions might have biased their interpretations of the data. Consequently, we tried to validate the data analysis by recognizing and ignoring the irrelevant assumptions. Also, Mixed methods studies are suggested to understand e-learning problems in the post-covid era better.

These findings suggest that teachers must become trained the most proficient in e-learning and technology-enhanced learning, and this capability should continue. Special attention should be paid to open educational platforms. The use of e-learning as a response to covid has been accepted and continued. The place of learning in educational institutions should be reviewed. Support infrastructures for instructors and students should be provided. Managers and educational leaders should be encouraged and guided toward adaptive educational design.

At the beginning of the outbreak of the Covid-19 pandemic, due to many reasons, including the resistance of teachers and learners to this approach and the lack of necessary infrastructure, the design and implementation of virtual education faced challenges. The teachers had many problems, such as weakness in class management, interference of roles, and even family restrictions. However, with time, the redoubled efforts of the teachers and the management of multiple roles by them, strengthening their knowledge in distance learning and e-content creation, and more participation in e-learning caused an increase in the quality of education. However, planning and foresight are needed in developing countries, including Iran, to appropriately face and optimally manage similar crises and move towards blended learning.

Acknowledgments

This research was conducted within the framework of an MSc thesis. We want to thank all the participants.

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• 10. Garland VE. From digital exclusion to digital inclusion for adult online learners. Advanced Methodologies and Technologies in Modern Education Delivery: IGI Global; 2019. p. 345–55.
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• Published: 13 April 2024

Burdens and resources of Austrian clinical psychologists: results of a qualitative study two years into the COVID-19 pandemic

• Andrea Jesser 1 , 2 ,
• Agnes Steinböck 1 ,
• Barbara Pammer 3 ,
• Tiam Ghorab 1 ,
• Magdalena Weber 1 ,
• Yvonne Schaffler 1 ,
• Thomas Probst 4 ,
• Anna Felnhofer 5 ,
• Oswald D. Kothgassner 6 ,
• Christoph Pieh 1 &
• Elke Humer 1 , 2  

BMC Psychology volume  12 , Article number:  205 ( 2024 ) Cite this article

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The COVID-19 pandemic increased the mental health burden in the general population, enhancing the demands placed on mental healthcare professionals.

This study aimed to assess the burdens and resources of clinical psychologists that emerged since the beginning of the pandemic. N = 172 Austrian clinical psychologists participated in a cross-sectional online survey between April and May 2022. The burdens and the sources of support that emerged during the pandemic were analyzed using qualitative content analysis.

Mental health-related issues were identified as the greatest burden, followed by work-related themes and restrictions imposed by the government to combat the spreading of the virus. The most important resources mentioned by the clinical psychologists were social contacts and recreational activities. Practising mindfulness and focusing on inner processes and work-related aspects were further important resources mentioned.

Overall, it seems that clinical psychologists have a high awareness of mental health-related problems related to the pandemic and use adaptive coping strategies to deal with them.

Peer Review reports

Various studies have shown that the COVID-19 pandemic had a wide range of effects on society. In addition to the disease itself and the fear of infection, the accompanying measures, such as lockdowns and physical distancing, had a major impact on our lives, particularly our physical and mental health [ 1 , 2 , 3 , 4 ].

The government in Austria imposed the first lockdown on March 16, 2020. The lockdown was accompanied by major restrictions and ended on May 1, 2020. The obligatory COVID-19 lockdown measures entailed a nationwide curfew with restrictions on movement and activities. Exceptions included addressing immediate danger, meeting basic needs, fulfilling work responsibilities (if unable from home), providing care for those in need, and engaging in outdoor activities. As a second COVID-19 wave followed in the fall of 2020, a second lockdown was decreed from November 17 until December 6, 2020, followed by a third lockdown from December 26 until February 7, 2021. Due to the emergence of the SARS-CoV-2 Delta variant, the number of infected people strongly increased again in the autumn of 2021. A further lockdown was imposed from November 22, 2021. For vaccinated people, the lockdown ended on December 11, 2021, and for unvaccinated people on January 31, 2022. On February 5, 2022, a vaccination obligation came into force in Austria, which was repealed on July 29, 2022. Our study was conducted during April and May 2022. At this time, the Omicron variant was dominant in Austria. After daily highs in confirmed COVID-19 cases from January to March 2022, infection rates declined in April 2022. The milder course of the Omicron variant allowed strong relaxation of the containment efforts in spring 2022. At the time of the survey, only a few measures were in place, such as mandate masking in essential shops, hospitals, and nursing homes and the need to prove a low epidemic risk upon entering Austria [ 5 ]. However, the existence of compulsory vaccination at the time of the survey and the socio-political discussion about it did not help to ease the general mood among the population [ 6 ].

Already at the time of the first lockdown, mental health problems increased in the general population in Austria, with prevalence rates of 21% for clinically relevant symptoms of depression, 19% for anxiety, and 16% for insomnia [ 7 ]. Comparable representative population studies from before the pandemic found that 6% of the population scored above the same cut-off for depression and anxiety [ 8 , 9 ]. Further studies showed that adverse effects persisted beyond the lockdowns [ 2 , 10 ] and increased even further, reaching a prevalence of 28% for depression in April 2022 [ 11 ].

With the rise in mental health problems, the demand for professional psychological support and the number of patients being treated also increased in Austria [ 12 , 13 ]. Besides psychiatrists, psychotherapists and clinical psychologists are involved in the treatment of mental health problems in Austria. The professional title “psychotherapist” may only be used by persons who have completed training that meets the requirements of the Austrian Federal Ministry of Social Affairs, Health, Care, and Consumer Protection. There is a wide range of established psychotherapy methods, which can be classified into four orientations (psychodynamic, humanistic, systemic, behavioral) [ 14 ]. The training qualifies for treatment based on one of the recognised methods. To work as a clinical psychologist, it is necessary to complete in-depth postgraduate training in addition to a degree in psychology and to have practical experience in a health or social service institution. Clinical psychological treatment includes the use of clinical psychological approaches based on the science of psychology, its findings, theories, methods and techniques [ 15 ] and therefore goes beyond single methods. This study focuses on the group of clinical psychologists in Austria.

The well-being of mental health professionals is crucial for successful treatment [ 16 ]. Therefore, the question arises as to how much they have been burdened. After all, mental health professionals are also affected by the pandemic and are at risk of experiencing adverse mental health outcomes [ 17 ].

Previous studies have shown that health professionals in general were particularly challenged during the pandemic. This is reflected in the collected findings of several meta-analyses, which reported anxious and depressive symptomatology, sleep disorders, or burnout in health professionals [ 18 , 19 , 20 ]. However, most of these studies refer to the group of physicians and nurses, and there is less empirical evidence on mental healthcare professions, such as clinical psychologists or psychotherapists. Also, existing studies considering these professions are contradictory.

For example, a study on 1,547 psychotherapists in Austria indicated that their stress level was higher during the pandemic than reference values measured in the general German population before the pandemic [ 21 ]. Possible stressors included fear of infection in direct patient contact or changes in everyday practice such as switching to remote psychotherapy, working with a mask, dealing with waiting lists due to increased need for psychotherapeutic treatment, or changes in patient's existing symptoms [ 22 , 23 ]. Similarly, Rosen et al. [ 24 ] reported increased burnout among psychotherapists during the COVID-19 pandemic. Since burnout is related to perceived stress in professional counsellors, this finding also points to increased stress levels among psychotherapists [ 25 ].

The extent to which mental health professionals feel stressed can be influenced by their coping strategies. It could be shown that avoidant coping strategies (such as denial, distraction, and substance use) were associated with increased stress levels, which predicted lower well-being. On the other hand, active coping (e.g., positive attitude, problem-solving, social support) positively affected well-being and was negatively associated with psychological distress [ 26 , 27 , 28 , 29 ]. Resources such as physical activity, relaxation at work, mindfulness-based resilience training programs, or practising autogenic training have been recommended in this context [ 30 ].

While the studies mentioned above suggested that mental health professionals were particularly burdened by the pandemic, results of a recent survey by Schaffler et al. [ 31 ] indicated that Austrian psychotherapists had fewer problems with depressive, anxiety, insomnia, and stress symptoms than the general population. Similarly, Austrian telephone emergency counsellors have been found to experience less stress and better mental well-being compared to a representative sample of the general population [ 32 , 33 ].

Studies focusing on clinical psychologists are rare and their results also point in different directions. In 2015, a study of 678 UK-based clinical psychologists found that 63% of them reported having experienced mental health problems at some point in their lives, while the lifetime prevalence of diagnosable mental health problems in the general population was considerably lower at 41% [ 34 ]. In contrast, an Austrian study of N = 172 clinical psychologists revealed a lower prevalence of depression, anxiety, and clinically relevant stress levels in clinical psychologists compared to the Austrian general population in spring 2022 [ 35 ]. 12.2% of clinical psychologists exceeded the cut-off scores for clinically relevant depression and anxiety (compared to 24% and 20% in the general population), 43% reported a moderate or high stress level (compared to 64% in the general population). Another study on healthcare workers in Brazil found that clinical psychologists had the lowest scores regarding the psychological impact of the pandemic. Their training and ability to develop adaptive strategies were discussed as protective factors [ 36 ].

In sum, empirical data on the impact of the COVID-19 pandemic on mental health professionals are still scarce and contradictory. Although the pandemic challenged health professionals, Austrian clinical psychologists seem less mentally burdened than the general population [ 35 ]. However, the underlying reasons remain unclear so far. To better understand stressors and protective factors clinical psychologists faced two years into the pandemic, our study aimed to investigate their self-reported burdens and the resources.

Study design

Between April 11 and May 31, 2022, a cross-sectional internet-based survey was conducted using Research Electronic Data Capture (REDCap) (Vanderbilt University, Nashville, TN, USA) [ 37 ]. The survey constituted 49 items in total. Results on the quantitative analyses are presented in our companion paper [ 35 ]. The link to the survey was sent via e-mail to clinical psychologists registered in the list of the Austrian Federal Ministry of Social Affairs, Health, Care and Consumer Protection (>11000 clinical psychologists registered in April 2022), given that they provided a valid e-mail address (≈5000 clinical psychologists). Several clinical psychologists were also registered as psychotherapists in the list of the Austrian Federal Ministry of Social Affairs, Health, Care and Consumer protection. As psychotherapists were also invited to participate in a survey on the same topic (results published in our companion papers [ 31 , 38 ]), the current analyses encompassed only clinical psychologists without additional license as a psychotherapist (≈ 3000 eligible participants).

The study was conducted after approval by the data protection officer and the Ethics Committee of the University for Continuing Education Krems, Austria (Ethical number: EK GZ 11/2021-2024). All participating clinical psychologists gave electronic informed consent to participate and complete the questionnaires. Clinical psychologists received no compensation for their time and effort, and participation was voluntary.

Sociodemographic and job-related variables

Data on gender, age, and years in the profession (the time since participants were registered in the official list of licensed clinical psychologists) were collected. All participants were further asked about their employment type (private practice, outpatient institution, inpatient institution) and whether they derived all their income from their clinical psychological treatments. They were further asked about the number of patients treated clinically-psychologically on average per week in personal contact, via the Internet, and the telephone. Other job-related variables surveyed were the treated patient group (children and adolescents, adults) and the setting in which treatment was provided (treating individuals, partners, families, or groups).

Open-ended questions on perceived burdens and resources

To evaluate the perceived burdens and resources of clinical psychologists during a period of consecutive crises, the following five free-text questions were asked:

What currently burdens you the most?

How do these burdens currently show themselves?

If you look back today at the last two years: What effects of the pandemic on your mental health and well-being have you observed?

What helped you to cope with the adverse effects of the pandemic?

Have there also been positive effects due to the pandemic?

Both questions and answers were initially formulated in German. As there were no predefined possible answers, the respondents were allowed to describe their own experiences. Responses ranged from single-word answers to whole paragraphs. It was also possible to skip each of the free-text questions.

Sociodemographic data were analyzed descriptively to describe the characteristics of the sample. The data derived from the open-ended questions were analyzed by two coders using conventional qualitative content analysis, followed by quantifying the qualitative categories [ 39 ]. After an initial review of the data, it was decided to analyze the answers to questions 1-3 and 4-5 together. Answers to questions 1-3 could be thematically assigned to clinical psychologists’ burdens and responses to questions 4-5 to their resources.

The first coder analyzed the questions regarding the burdens (Questions 1-3), and the second coder addressed the questions concerning the resources (Questions 4-5). For this purpose, both coders first read all the data to familiarize themselves with the material and gain an overview. The responses were then read again word for word. In this process, categories for questions 1-3 and 4-5 were derived inductively, and category definitions, coding rules, and exemplary citations were documented in a codebook. After that, the coders subsumed subcategories with similar content under more abstract categories. This resulted in one category system for questions 1-3 and one for questions 4-5. The created category systems were then discussed with the research team regarding their applicability.

In the next step, the coders coded their respective datasets with their list of categories using the software ATLAS.ti [ 40 ]. As respondents were free to mention several aspects per question, assigning more than one category per response was possible. After the coders had coded the entire data set, they read all quotations assigned to one category. During this process, coding errors were corrected, and definitions and coding rules were made more precise. Subsequently, a third coder coded N =50 (28.4%) out of N =172 cases according to the coding rules, category definitions, and quote examples defined in the codebook to check for intercoder-reliability. The latter was calculated as the ratio of matching codings divided by the number of cases coded by both coders. The criterion for a matching case required both coders to apply the same categories to the case coded. Our approach resulted in an intercoder-reliability coefficient of r = 0.88. The mismatching cases were discussed with the research team, and final adaptations were made to the category systems.

Study sample characteristics

A total number of N = 172 clinical psychologists participated (≈ 6% response rate). The sample comprised only clinical psychologists without additional training in psychotherapy. Study sample characteristics are summarized in Table 1 .

Within the questions related to burdens (questions 1-3), out of N =172, N =152 (88.4%) answered at least one question, N =144 (83.7%) at least two questions and N =133 (77.3%) answered all three questions.

Qualitative content analysis resulted in 10 categories (Fig. 1 ) with 21 subcategories. The results are described in detail in Table 2 .

Burdens among clinical psychologists. The percentages of participants reporting one or more burdens in each of the main categories that resulted from the qualitative content analysis of questions 1-3: (Question 1) What burdens you the most at the moment? (Question 2) How do these burdens currently show themselves? (Question 3) If you look back today at the last two years: What effects of the pandemic on your mental health and well-being have you observed?

Mental health

The largest category, mentioned by N =133 (77.3%) respondents, relates to aspects of mental health and includes six subcategories (Table 2 ).

Within this category, we saw that 48.8% ( N =84) clinical psychologists felt most burdened by negative feelings, e.g., unhappiness, fear, tension, or anger, as well as the absence of positive feelings.

N =63 (36.6%) wrote about burnout symptoms. Sleep problems, fatigue, and lack of energy were reported particularly frequently, for example, by respondent 219 , who stated, “tiredness, falling asleep very quickly on the couch in the evening after the children are in bed, hardly have any energy for things that I could enjoy myself” when asked about how her burdens currently show themselves.

Another N =57 (33.1%) clinical psychologists addressed “excessive demand” as a burden. In their statements, respondents described feelings of stress and problems with time management, such as “too many tasks at once: very busy day, job, diagnostic findings, everyday life with two children, dog” (respondent 270) . In this context, respondents also mentioned an increase in negative habits (e.g., screen time, alcohol consumption, procrastination) and decreased positive habits (e.g., regular exercise, social gatherings, healthy eating).

N =36 (20.9%) respondents felt burdened by rumination. They wrote about constant worrying and circling of thoughts.

N =11 (6.4%) referred to a specific mental health disorder, and N =6 (3.5%) were worried about mental health and harmful habits of friends and family.

N =65 (37.8%) respondents named aspects of work as a burden. This main category comprised 4 subcategories (Table 2 ).

N =39 (22.7%) respondents experienced a high workload as a burden. Respondents were troubled by long working hours, a high number of patient requests, and increased mental disorders among their patients. Respondent 403, who reported an extreme influx to the practice and feeling unable to help enough, wrote: “We don't know where to send people anymore; all colleagues are overloaded” . Statements also included direct consequences of this situation on their work, e.g., poor treatment quality.

Further, N =29 (16.9%) respondents mentioned burdens due to working conditions. Aspects like an uncertain working situation, poor pay, postponed appointments, or irregular working hours were found to be challenging.

Other N =9 (5.2%) respondents described burdens related to the workplace atmosphere, such as interpersonal problems within the team and conflict at the workplace. Moreover, N =6 (3.5%) respondents felt burdened by a lack of patients.

COVID-19 restrictions

Another area of concern mentioned by N =57 (33.1%) respondents relates to COVID-19 restrictions. Statements referred to restrictions such as lockdowns, compulsory vaccination or masks, and their consequences. Limited opportunities for recreational activities and lack of social contact were repeatedly addressed. Respondent 24, displeased by the measures, wrote: “I miss shaking hands and hugs.” Contrary to that, the absence and relaxation of restrictions were also perceived negatively, as respondents felt insufficiently protected.

Global crises

N =46 (26.7%) respondents named worries about three current global crises and their consequences a burden. The three subcategories are summarized in Table 2 .

N =42 (24.4%) respondents made statements relating to the current Ukraine-Russia conflict.

Further, N =12 (7%) addressed the “pandemic” as a burden. Within this category, almost exclusively single-word responses like “pandemic” or “corona” were coded.

Moreover, N =6 (3.5%) said they were concerned about the climate crisis.

Physical health

N =45 (26.2%) respondents reported physical health complaints. N =41 (23.8%) mentioned general concerns about their health as well as specific symptoms such as somatic pain, muscle tension, and gastrointestinal problems.

Another N =9 (5.2%) were concerned about the physical health and death of close people.

Other burdens

N =28 (16.3%) respondents reported burdens related to their friends and family. For N =25 (14.5%), such burdens referred to issues associated with their children, e.g., children’s progress at school or childcare. N =14 (8.1%) described interpersonal problems, which were often related to differing attitudes toward COVID-19.

A further category, named by N =28 (16.3%) respondents, concerns dissatisfaction with societal development. N =19 (11%) expressed dissatisfaction with the general societal development. Respondent 634, for example, stated: “The increase in people's inability to hold conversations and lack of tolerance to accept other points of view. The split of the middle class. That people are more incapable regarding their social competencies (interpersonal interaction, empathy).” For N =13 (7.6%) the dissatisfaction was related to politics and media reporting regarding COVID-19 or other topics.

Another area of burden, addressed by N =20 (11.6%) respondents, refers to finances. In this context, N =13 (7.6%) reported general worries regarding their personal financial situation, and N =7 (4.1%) were concerned about inflation.

N =9 (5.2%) made vague statements that they were worried about the distant future.

Among the questions related to resources (questions 4-5), N =150 (87.2%) answered at least one question, and N =133 (77.3%) answered both questions.

Qualitative content analysis resulted in eight categories and 23 subcategories. Fig. 2 depicts the percentages of the main resource categories. All findings are described in detail in Table 3 .

Resources respondents accessed to deal with burdens. The percentages of respondents reporting one or more resources in each of the main categories that resulted from the qualitative content analysis of questions 4-5: (Question 4) What helped you to cope with the adverse effects of the pandemic? And (Question 5) Have there also been positive effects due to the pandemic?

Social contacts

The category “social contacts”, an important resource for 68% ( N =117) of the respondents, consists of five subcategories (Table 3 ).

Most respondents ( N =84; 48.8%) mentioned “Partners, family and friends” as a source of support. Respondents felt it was a resource to spend more time together and have a stronger connection with close family and friends, which they associated with having more time than usual during the pandemic.

Further, N =35 (20.3%) respondents mentioned other social contacts and conversations in general as a resource, and N =15 (8.7%) referred to colleagues as a social support network.

While most respondents drew on social contacts as a resource, N =13 (7.6%) stated that they felt relieved by having fewer social contacts and obligations, e.g., family gatherings or more options for social withdrawal when needed during the pandemic.

Finally, N =9 (5.2%) referred to their pets as a resource.

Recreational activities

N =77 (44.7%) respondents mentioned recreational activities as a resource. The main category comprises three subcategories displayed in Table 3 . Across all statements, respondents emphasized that having time for themselves was a positive effect of the pandemic.

N =38 (22.1%) respondents enjoyed being outside in nature. This subcategory included going for walks, spending time, or meeting friends outside.

Exercising was perceived as helpful by N =37 (21.5%) respondents. Statements within the subcategory “sports” encompass activities such as running, weightlifting, martial arts, mountain climbing, or just investing more time in doing sports.

N =26 (15.1%) respondents mentioned that finding new or indulging in existing hobbies, e.g., cooking, baking, making or listening to music, creating art, writing, watching movies, gardening, or reading, was a resource during the pandemic.

Mindfulness

Practising mindfulness was a resource for N =71 (41.3%) respondents.

The calmness and deceleration of pace in everyday life, summarised in the subcategory “slowing down”, was mentioned by N =40 (23.3%) respondents. Respondents indicated there was less pressure to use leisure time productively and that, especially during curfews, they participated less in public life and retreated to the private sphere.

Further, N =29 (16.9%) respondents referred to “prioritizing” as a resource. They reported that concentrating on important things, focusing on or changing priorities, focusing on oneself or one’s own life, and finding clarity on what is important were positive effects of the pandemic. Prioritizing could be considered a mental mindfulness technique but differs from these by the passive nature of the formulation of responses. Respondents did not refer to specific practices or techniques but to states of serenity due to a decelerated environment.

N =29 (16.9%) respondents referred to a related but distinct subcategory comprising particular exercises, including techniques for mindfulness, relaxation, meditation, breath work, and emotionality. They voiced being actively mindful of small things and living in the moment.

Inner processes

Another main category N =58 (33.7%) reported as a resource during the pandemic, relates to inner processes. As summarized in Table 3 , N =24 (14%) respondents mentioned their “positive attitude” as a resource throughout the pandemic. Respondents described focusing on the positive side of things and looking to the future with confidence. For example, respondent 1 reported : “my generally positive attitude towards things, which actively counteracts when I notice my mood getting bad.”

N =23 (13.4%) respondents described their flexibility and adaptability in dealing with the pandemic as a resource. They named their courage, emotional stamina, confidence, and competence to handle a situation or face fears. We subsumed these statements under the subcategory “resilience”, which can be defined as the process of successfully navigating, adapting to, or managing adversity, stressors or traumatic experiences [ 41 ].

N =21 (12.2%) respondents mentioned self-reflection as a resource and reported confronting their feelings. For example, respondent 110 described the pandemic as an “opportunity to become aware of and integrate one’s fears” . Actively reflecting on the pandemic situation also helped respondents to develop new perspectives in dealing with COVID-19 measures. As respondent 158 expressed, “I have tried to put the processes and measures in perspective. My attitude is: there are a lot worse things than having to wear masks.”

Work-related changes due to the pandemic were relevant for N =54 (31.4%) respondents. Subcategories are displayed in Table 3 .

The pandemic entailed working from home and changed working conditions in many places. Positive mentions of this also came from the respondents in our study and were subsumed under the subcategory “flexible working conditions”, which was named by N =30 (17.4%) respondents. They described working digitally or from home, which saved time and mental resources.

Further N =17 (9.9%) respondents mentioned their work in general as a resource during the pandemic.

N =8 (4.7%) commented positively on increased recognition of psychosocial services by political actors, the media, or society in general. Related to this, they observed a greater number of patients and professional inquiries.

At the same time, N =8 (4.7%) respondents reported that they noticed a decreased workload, which was also experienced positively. Respondents reported fewer clients, fewer appointments and work commitments, especially during curfews in the first year of the pandemic.

A positive effect of the pandemic, mentioned by N =30 (17.4%) respondents, was the increased importance of health.

N =19 (11%) respondents noticed a stronger drive to maintain physical and mental health. They supported the introduction of protective measures against diseases, including COVID-19.

N =11 (6.4%) respondents additionally reported seeking professional support related to their health, such as supervision, psychotherapy, or physiological medical care.

Other resources

In addition, N =7 (4.1%) respondents mentioned structure, routines, and self-organization in their private and professional environment as a resource throughout the pandemic. An increase in available financial resources was noted in N =5 (2.9%) cases due to lower expenses or higher income. Further N =4 (2.3%) respondents drew resources from vacations.

The study illuminates the significant challenges faced by clinical psychologists during the pandemic, with mental health-related issues and work-related stressors being prominent concerns. These findings are consistent with previous research highlighting the strain experienced by healthcare workers during the COVID-19 crisis [ 19 , 20 , 42 ]. However, specific findings for mental healthcare professionals demonstrated variations in experiences [ 21 , 24 , 32 , 36 ]. The extent and nature of these challenges may vary across countries due to differences in healthcare systems, pandemic management strategies, and cultural factors.

In Austrian clinical psychologists lower rates of clinically relevant mental health problems compared to the general population were observed [ 35 ]. Results of the current study suggest heightened awareness of the pandemic’s impact in this specific group of healthcare professionals compared to the general public. While mental health was the most prominent main burden category in clinical psychologists (mentioned by 77.3%), it was less frequently mentioned (10.5% of the total sample) in the general population surveyed at the same time when asked about the current greatest source of problems [ 43 ]. However, only 6.4% of the clinical psychologists referred directly to their mental health disorders, which is still lower than the number of clinical psychologists scoring above the cut-offs for clinically relevant mental health problems (12.2% for depression and anxiety, 43% for stress) [ 35 ].

Next to mental health issues, work-related themes were frequently mentioned as a burden by the participating clinical psychologists. Clinical psychologists felt burdened by an increased demand for psychological services, which is in line with a recent study on changes in patient numbers of Austrian psychotherapists throughout the pandemic [ 13 ]. This study observed that after an initial decline in patient numbers during the first nationwide lockdown in the spring of 2020, patient numbers increased, exceeding pre-pandemic numbers in 2021 and 2022.

The frequent mention of mental health issues and work-related stressors highlights the need for clinical psychologists to foster mental hygiene to provide high-quality services during multilevel crises.

Other burdens mentioned by clinical psychologists reflect the pandemic-related restrictions and the current socio-political and economic situation. However, given that inflation rates experienced a dramatic upsurge in the early months of 2022 [ 44 ], the low proportion of clinical psychologists expressing worries about their personal financial situation (7.6%) indicates that this group mainly consists of individuals with financially satisfactory life situations. The preventive role of economic security on mental health is strengthened by multivariable analyses conducted on a representative sample of the Austrian general population surveyed in April 2022, showing that among several sociodemographic factors, household income was one of the variables strongest associated with mental health [ 11 ]. The improved financial position of clinical psychologists compared to the general population in Austria is also indicated by the frequent mentions (30.4%) of concerns regarding inflation and finances as the main source of worry among the Austrian general population expressed in a survey in April 2022 [ 43 ].

Regarding resources for coping with stress, clinical psychologists were found to rely mainly on positive coping strategies, such as seeking social support, engaging in recreational activities, and practicing mindfulness or positive thinking. These are associated with lower levels of psychological distress [ 27 ] and stress symptoms [ 45 ] in mental health professionals.

In contrast to the areas of concern, the mentioned resources showed high similarity between clinical psychologists and the general population [ 43 ]. In both groups, social contacts had the highest overall score of all resources mentioned. Previous studies support the role of social relationships in mitigating mental health symptoms during the pandemic [ 46 , 47 , 48 ]. In a review of 31 studies on the coping behaviors of healthcare workers, Labrague [ 49 ] found support from and communication with family, friends and colleagues to be a primary coping mechanism for managing adverse consequences of the COVID-19 pandemic.

Recreation was the second most frequent category mentioned by clinical psychologists and the Austrian general population surveyed in spring 2022 [ 43 ]. This category comprised spending time in nature, practicing sports, and finding new or indulging in existing hobbies. The importance of physical activity for mental health has been highlighted in several previous studies [ 11 , 50 , 51 , 52 ].

Practising mindfulness was the third most vital resource. Respondents were very explicit in naming various mindfulness techniques, possibly due to their professional backgrounds. Previous studies support the potential of mindfulness practice to strengthen resilience and the ability to cope with adversity during crises [ 53 , 54 , 55 ].

Focussing on inner processes was reported as an important resource by more than one third of clinical psychologists, with positive thinking, self-confidence, and self-reflection frequently mentioned. The preventive role of a positive attitude is supported by a study conducted on the Austrian general population during the first COVID-19 lockdown, demonstrating that positive thinking was associated with less perceived stress, depression, anxiety, and insomnia [ 29 ]. The positive attitude of clinical psychologists is also reflected in the low proportion (11%) of participants stating that the pandemic was not associated with any positive aspect. Waters et al. [ 56 ] suggested an interaction between positive emotions and psychological distress. They argued that positive emotions serve to (1) diminish mental health threats, (2) maintain mental health, and (3) enable the individual to use a crisis in a transformative way to develop new perspectives or strategies. Quotes from our study illustrate that clinical psychologists, similar to respondents interviewed by Yang et al. [ 57 ], resorted to strategies such as positive refocusing (e.g. turning to the positive things in life) or positive reappraisal (e.g. focusing on what can be learned from the situation).

Work was also mentioned by almost one third of the participating clinical psychologists as an important resource, while it was named by only about 4% of the general population [ 43 ]. The frequent mentions of clinical psychologists may have several reasons. For one, the pandemic went along with changes in the clinical psychologists` working conditions, such as increased flexibility due to the possibility of working from home and even treating patients from a distance. Moreover, the high mental health burden in the general population increased the awareness of the importance of mental healthcare services by policymakers, the media, and society in general. It might be possible that self-experienced job-related meaningfulness, a well-known protective factor against job-related distress and associated mental health disorders [ 33 , 58 ], even increased in clinical psychologists during the pandemic. Research has also shown that supporting others can help people cope better with crises [ 59 , 60 ]. Supporting their patients through the pandemic may have become a resource for clinical psychologists to better manage themselves.

This study has several limitations. First, the written conduct of the study reduced the possibility of deriving more contextually embedded and coherent information as it would be possible in personal interviews. Second, all questions were asked when less pandemic-related restrictions were in place, which might have caused some recall bias when asked about the burdens and resources experienced during the pandemic. Third, all burdens and resources mentioned are likely also affected by other crises, such as the war in Europe and the associated high inflation rates. Fourth, we have not differentiated how the experiences of different groups differ. For example, it is known from other studies that men and women deal with stress differently [ 61 ]. The work context also influences the stresses experienced and offers different ways of dealing with stressful situations. Frenkel et al. [ 62 ] showed that healthcare professionals in outpatient facilities experience more stress than those in inpatient contexts. They suggest team commitment and knowledge exchange can help buffer against adverse psychological stress responses. A large proportion of the clinical psychologists we surveyed work in private practice, where there is no guarantee of being part of a team. Winter et al. [ 13 ] have shown that the psychotherapists they interviewed wished for more opportunities for intervision, supervision and training to deal with work-related stress. This could also apply to clinical psychologists, so surveying their support needs in further research is necessary. A fifth notable limitation of this study is the low response rate of about 6%, which raises concerns about the representativeness of the sample. The reliance on online data collection may have introduced selection bias, as it is possible that clinical psychologists who chose to participate differed systematically from those who did not. Additionally, the online nature of the survey may have excluded clinical psychologists who do not have access to or are less inclined to participate in online surveys. Therefore, caution should be exercised when extrapolating these findings to the broader population of clinical psychologists.

Overall, it seems that clinical psychologists are characterized by a high awareness of mental health-related problems related to the pandemic and the usage of adaptive coping strategies to deal with them. These findings underscore the importance of proactive self-care strategies in maintaining well-being amidst crises.

The evolving work conditions for clinical psychologists, including increased flexibility and heightened awareness of mental healthcare services, highlight the resilience and adaptability of the profession. Future research should explore support needs and interventions for managing work-related stress effectively. Moreover, there is a need to collect more detailed information on the personal experiences of different groups (e.g., vulnerable vs resilient groups or women vs men).

Overall, prioritizing mental health and leveraging available resources are crucial for clinical psychologists to continue providing essential support during challenging times.

Availability of data and materials

The dataset used and analyzed during the current study is available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank the participating clinical psychologists for their time and efforts participating in the surveys—Open Access Funding by the University for Continuing Education Krems.

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Andrea Jesser, Agnes Steinböck, Tiam Ghorab, Magdalena Weber, Yvonne Schaffler, Christoph Pieh & Elke Humer

Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, 1020, Austria

Andrea Jesser & Elke Humer

Clinical Psychologist and Psychotherapist, Graz, Austria

Barbara Pammer

Division of Psychotherapy, Department of Psychology, Paris Lodron University of Salzburg, Salzburg, 5020, Austria

Thomas Probst

Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria

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Conceptualization, A.J., Y.S., E.H., and T.P.; methodology, A.J., and E.H.; validation, A.J.; formal analysis, A.S., T.G., M.W., and A.J.; investigation, E.H.; data curation, E.H., A.F., and O.K.; writing—original draft preparation, A.J., E.H., A.S., and B.P.; writing—review and editing, T.G., M.W., A.F., O.K., Y.S., T.P., and C.P.; visualization, A.S., and E.H.; supervision, A.J., and E.H.; project administration, E.H. All authors have read and agreed to the published version of the manuscript.

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Jesser, A., Steinböck, A., Pammer, B. et al. Burdens and resources of Austrian clinical psychologists: results of a qualitative study two years into the COVID-19 pandemic. BMC Psychol 12 , 205 (2024). https://doi.org/10.1186/s40359-024-01714-9

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The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses working in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation

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The COVID-19 pandemic resulted in significant physical and psychological impacts for survivors, and for the healthcare professionals caring for patients. Nurses and doctors in critical care faced longer working hours, increased burden of patients, and limited resources, all in the context of personal social isolation and uncertainties regarding cross-infection. We evaluated the burden of anxiety, depression, stress, post-traumatic stress disorder (PTSD), and alcohol dependence among doctors and nurses working in intensive care units (ICUs) in Nepal and explored the individual and social drivers for these impacts.

We conducted a mixed-methods study in Nepal, using an online survey to assess psychological well-being and semi-structured interviews to explore perceptions as to the drivers of anxiety, stress, and depression. Participants were recruited from existing national critical care professional organisations in Nepal and using a snowball technique. The online survey comprised of validated assessment tools for anxiety, depression, stress, PTSD, and alcohol dependence; all tools were analysed using published guidelines. Interviews were analysed using rapid appraisal techniques, and themes regarding the drivers for psychological distress were explored.

134 respondents (113 nurses, 21 doctors) completed the online survey. Twenty-eight (21%) participants experienced moderate to severe symptoms of depression; 67 (50%) experienced moderate or severe symptoms of anxiety; 114 (85%) had scores indicative of moderate to high levels of stress; 46 out of 100 reported symptoms of PTSD. Compared to doctors, nurses experienced more severe symptoms of depression, anxiety, and PTSD, whereas doctors experienced higher levels of stress than nurses. Most (95%) participants had scores indicative of low risk of alcohol dependence. Twenty participants were followed up in interviews. Social stigmatism, physical and emotional safety, enforced role change and the absence of organisational support were perceived drivers for poor psychological well-being.

Nurses and doctors working in ICU during the COVID-19 pandemic sustained psychological impacts, manifesting as stress, anxiety, and for some, symptoms of PTSD. Nurses were more vulnerable. Individual characteristics and professional inequalities in healthcare may be potential modifiable factors for policy makers seeking to mitigate risks for healthcare providers.

Peer Review reports

Introduction

Between January 2020 and December 2021, the COVID-19 pandemic led to an estimated 18.2 million deaths [ 1 ]. Globally, healthcare systems were overwhelmed during the pandemic, with intensive care units (ICUs) receiving an unprecedented burden of patients [ 2 ]. In Nepal, the government first declared a lockdown on March 24, 2020, that lasted until July 21, 2020, and the second lockdown was announced on April 29, 2021, which was fully lifted on September 1, 2021 [ 3 ]. The first wave of the COVID-19 pandemic reached a peak of over 5000 cases a day in October 2020, and the second wave reached a peak of more than 9000 cases a day in May 2021, which was almost double [ 4 ]. Prior to the pandemic, Nepal reported a capacity of 1595 ICU beds across 194 hospitals and around 840 ventilators, equating to 2.8 ventilator-equipped ICU beds per 100,000 people [ 5 ]. To cope with the influx of COVID-19 patients, several existing postoperative wards and other high-dependency units of the hospitals were converted into improvised critical care units [ 6 ]. Globally, healthcare professionals (HCPs) and specifically those working in ICU and critical care services, arguably were at the frontline of the healthcare response. These HCPs faced the uncertainty of managing this new condition, extended working hours, limited personal protective equipment (PPE), and an increased risk of infection as they provide essential lifesaving interventions, including intubation and non-invasive respiratory management [ 7 , 8 ].

The impacts of the COVID-19 pandemic on the mental health and well-being of HCPs who worked during and after this global emergency are slowly becoming apparent. Research emerging from China, the USA, and Europe [ 9 ] describes a significant burden of psychological distress and symptoms synonymous with mental health conditions in HCPs. This is also evident from the limited studies that have been conducted in Nepal. For instance, one study conducted among 150 HCPs from outpatient clinics and inpatient wards caring for COVID-19 patients in Nepal reported that 38% of participants suffered from anxiety and/or depression [ 10 ]. Another Nepali study revealed that the prevalence of anxiety and depression among HCPs, including health assistants and support staff was 47% and 41%, respectively [ 11 ]. A larger online survey of 475 HCPs including pharmacists, paramedics and public health practitioners reported similar findings (42% had anxiety) and noted that nurses had a higher proportion of symptoms compared to other HCPs [ 12 ].. Whilst these studies, in conjunction with a meta-analysis, indicate that depression, anxiety, and post-traumatic disorder (PTSD) are highly prevalent among HCPs during the pandemic [ 9 , 10 , 11 , 12 , 13 ], fewer studies have explored the disparities between professionals’ roles, specifically among ICU workers, a group exposed to more advanced cases of COVID-19. Indeed a small study in Nepal comprising 96 nurses revealed that nurses who worked directly with COVID-19 patients experienced more severe symptoms of depression and anxiety [ 13 ]. The nature and characteristics of mental health symptoms appear to vary geographically, the HCPs’ role, their individual characteristics (age, gender) along with health system’s pre-existing resource capacity and ability to respond to increasing demand placed by events such as a pandemic. Understanding the mental health impact of ICU workers, any disparities between professional roles and drivers behind poor mental health in Nepal will help to identify what support is needed for ICU workers for pandemic preparedness; thus, providing important directions for investment in health systems strengthening.

We aimed to investigate the burden of anxiety, depression, stress, PTSD, and alcohol dependence among doctors and nurses in Nepal that worked in the ICU during the COVID-19 pandemic. We further sought to identify the factors driving the self-reported burden of psychological distress by exploring the lived experiences of these two different professional groups, and how these experiences impacted their psychological health and well-being.

Study design

We undertook a mixed-methods cross-sectional study [ 14 ] in Nepal with ICU doctors and nurses, combining an online questionnaire consisting of validated self-assessment tools combined with semi-structured interviews. The following self-reporting psychological assessment tools were used, given they have been used in previous studies in other settings and their widely validated in a variety of settings: Beck Anxiety Inventory (BAI) [ 15 ], Beck Depression Inventory (BDI) [ 16 ], Perceived Stress Scale (PSS) [ 17 ], PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 (PCL-5) [ 18 ] and Alcohol Use Disorder identification Tool (AUDIT) [ 19 ]. BDI, BAI, and AUDIT have been validated in Nepal [ 20 , 21 , 22 ] and the PSS has been tested for reliability and correlation in Nepal [ 23 ]. Whilst the PCL-5 has not been validated in a Nepali setting, it was piloted (along with all other assessment tools used) with 20 people before the study commenced. Participants were given the flexibility to complete the questionnaire in either Nepali or English language. Despite this option, all participants opted to respond in English.

Ethics approval

was granted from the Nepal Health Research Council (approval number: 176/2021 P). All participants provided informed consent electronically before completing the online questionnaire. Participants from the qualitative component provided further informed verbal consent before the interview commenced.

In 2020, Nepal reported a capacity of 1595 ICU beds across 194 hospitals and around 840 ventilators, equating to 2.8 ventilator-equipped ICU beds per 100,000 people [ 5 ]. A year later, Nepal was under a state of health emergency, with patients being turned down due to a lack of ICU beds, oxygen, and ventilators [ 24 ].

Participants and recruitment

Doctors and nurses with experience in caring for COVID-19 patients in Nepalese ICUs were eligible for participation. Initially doctors registered with the Nepalese Society of Critical Care Medicine (NSCCM) [ 25 ] and nurses registered with the Critical Care Nurses Association of Nepal (CCNAN) [ 26 ] were contacted and invited to participate. Both organisations consist of voluntary memberships and represent the doctors and nurses working in a critical care setting in Nepal. At the time of recruitment, there were 187 doctors and 104 nurses registered at these organisations. This initial purposive sampling was augmented by snowballing techniques, whereby respondents were invited to forward the questionnaire link to other doctors or nurses working in ICUs [ 27 ]. Following completion of the questionnaire, respondents were invited to participate in a virtual interview. A convenience sample of 20 participants (a number which, based on the literature, was likely to provide saturation of findings [ 28 ]) was subsequently scheduled for an interview.

Study materials and data collection

The questionnaire was developed using an online survey platform (Google Forms) [ 29 ]. The questionnaire was piloted for readability and responder reliability with twenty HCPs based in Nepal, prior to roll out, who did not participate in the final analysis. Questionnaire content included socio-demographic information; age, sex, professional role and experience, degree of schooling, and home living arrangements; factors which had been identified as being important in the burden of psychological distress and impact on family life in similar research conducted during the previous SARS pandemic as well as the current COVID-19 event [ 30 ]. Participants could opt out of the study at any time. Participants could only complete the questionnaire once, and all survey responses were anonymous. Participants were signposted to healthcare services available to them should they be suffering from any distressing, mild, moderate or severe mental health symptoms. Invitations to participate in the questionnaire were sent out from 20th May 2021, and the questionnaire was closed to responses on 2nd October 2021.

The semi-structured interview topic guide was co-developed between doctors and nurses working in ICUs in Kathmandu. Co-design was used to ensure the sensitivity and appropriateness of the questions. None of the doctors and nurses involved in the codesign of the topic guide participated in the study proper. The qualitative component was aimed to augment the quantitative findings by providing an understanding of what social, organisational, and environmental factors were related to HCPs’ mental health. Topic guide questions focused on HCPs’ perceptions of their experiences of working during the pandemic and explored social, organisational, and environmental factors that may have influenced their self-reported burden and symptoms of psychological distress. These factors were selected from a review of the findings of the previously published meta-analysis and other studies conducted in Nepal [ 9 , 10 , 11 , 12 , 13 ]. The interview questions were piloted with five HCPs for interpretability and interviewer consistency. All interviews were conducted via video conferencing (Zoom) [ 31 ] between September 2021 and March 2022. Five ICU nurses with experience in conducting interviews and mixed methods research led the data collection following training on the topic guide. To ensure there was no prior relationship between the interviewer and the participant, interviewers were assigned to participants that worked in different ICUs than themselves and were not known to the interviewee. No one other than the interviewer and the participant was present for each interview, and interviews were conducted at the time chosen by the interviewee. Rapid assessment procedure (RAP) sheets were used for note-taking during the interviews [ 32 ]. Commonly used in rapid evaluations - designed to improve the rapidity and replicability of research during public health emergencies - RAP sheets help reduce the need for long-form transcription and encourage reflexivity for both interviewers and researchers, reduce interviewer bias, and enable validation of internal consistency with coding [ 33 ]. The RAP sheet contained the summary of questions from the topic guide, and the interviewers took notes of what the participants said regarding each question during the interview.

Data analysis

Descriptive statistics were used to describe participants’ demographics and professional profiles. Psychological health and well-being assessment tools from the questionnaire were analysed using published guidelines. For the BDI, each of the 21 items corresponding to a symptom of depression was summed for each participant to give a single total score [ 16 ]. With each item ranging from 0 to 3 points, a total score of 13 or less was considered minimal to no depression, 14 to 19 as mild depression, 20 to 28 as moderate depression, and 29 to 63 as severe depression [ 16 ]. Data is also presented separately for suicidality (question 9 from the BDI) whereby anyone that said they have thoughts about or plans to kill themselves is said to have experienced suicidality. The BAI scores reported included the 21 symptoms of anxiety that ranged between 0 and 63 points [ 15 ]. The values for each symptom were summed, and a total score of 0 to 7 was interpreted as a minimal level of anxiety, 8 to 15 as mild, 16 to 25 as moderate, and 26 to 63 as severe anxiety [ 15 ]. Scores on the PSS ranged from 0 to 40, with higher scores indicating higher perceptions of stress [ 17 ]: scores ranging from 0 to 13 were considered low descriptors of stress; 14 to 26 moderate; and 27 to 40 were considered higher levels of perceived stress. For alcohol use disorder reported using AUDIT [ 19 ], a score of 0 indicated no previous or current alcohol use; a score of 1 to 7 suggested low-risk consumption; 8 to 14 hazardous or harmful alcohol consumption; 15 or higher indicated the likelihood of alcohol dependence (moderate to severe alcohol use disorder). The PCL-5 included 20 items with a score range of 0 to 80 and a score of 33 or higher, indicating the presence of PTSD [ 18 ]. A sensitivity analysis was conducted for the BDI, BAI and AUDIT scores based on local validation studies whereby a score of 15 or lower from the BDI indicated no depression [ 20 ], 12 or lower from the BAI indicated no anxiety [ 21 ], and a score of 11 or above from the AUDIT indicated discriminate dependent drinkers [ 22 ].

RAP sheets, along with interviewer notes, were reviewed by the research team before analysis to ensure information was complete. SK, KK and AB used a constant comparative method, coding data following each round of interviews and then reflecting back on the summary of the codes together with the interviewers to promote the accuracy of findings and reduce recall and interviewer bias. In addition, emerging themes identified following each round of coding were used to guide subsequent interviews [ 34 ]. The broader research team met following each coding round to review the findings and reflexivity [ 35 ]. Categories and the subsequent themes (‘drivers’) were developed through the iterative process of interviewing, coding, analysing, and reviewing.

We invited 120 doctors and 341 nurses to participate. A total of 21 doctors and 113 nurses responded, all of which completed the BDI, BAI, PSS, and AUDIT questions; 100 completed the PCL-5 (16 doctors and 84 nurses). Nearly all nurses were female (99%, n  = 112), whereas most doctors were male (81%, n  = 17). The characteristics of respondents are described in Table  1 .

50% ( n  = 67) of respondents reported experiencing symptoms associated with moderate to severe anxiety, and a further 27% ( n  = 36) scored for mild anxiety as a result of working in the ICU during the COVID-19 pandemic (Table  2 ). Anxiety levels (and associated symptoms) were more pronounced in nurses than doctors, with 55% ( n  = 62) of the former scoring moderate to severe on the anxiety scale, compared to 24% ( n  = 6) of the latter. 21% ( n  = 28) of respondents described symptoms associated with moderate to severe depression, with a near-even split between nurses and doctors. Three-quarters of respondents ( n  = 114; 85%) had scores indicative of moderate to high levels of stress; this proportion was higher among doctors ( n  = 19; 91%) compared to nurses ( n  = 95; 84%). Of the 100 individuals that completed the PCL-5 assessment (16 doctors and 84 nurses), 45% ( n  = 46) reported a constellation of symptoms closely associated with PTSD, with a higher prevalence among nurses ( n  = 40; 47%) compared to doctors ( n  = 6; 38%).

Using cut-off scores from Nepali validation studies, 45 (34%) participants were experiencing mild, moderate or severe depressive symptoms, 80 (60%) were experiencing mild, moderate or severe anxiety symptoms, and 3 (2%) were considered discriminate dependent drinkers. These results are in line with our main analysis, including that a greater proportion of nurses were still found to suffer from depression and anxiety symptoms (supplementary Table 1 ).

Forty-six respondents to the online questionnaire volunteered to participate in the subsequent semi-structured interviews. Twenty participants were approached and consented to an interview: 16 were nurses (all female), and 4 were doctors (1 female, 3 male). On average, each interview resulted in 45 to 60 min of qualitative data. Saturation was met within the first 15 interviews, and findings were consistent between the coders and the research team. Analysis and synthesis of the interviews revealed nine themes, which, when codified, can be described as three key drivers of the psychological symptoms and impacts on mental well-being experienced by the interviewees: social stigmatism, physical and emotional safety, and organisational support. (Fig.  1 ). During the interviews, HCPs further described some of the coping strategies that they found helpful in mitigating the impacts experienced and may provide insights for future pandemic preparedness. These three themes, the drivers, and coping strategies, are explored below, along with quotes from the respondents.

Coding tree for the four main drivers for psychological distress

Social stigmatism

Interviewees described experiencing feelings of social stigmatisation as a result of interactions with their families, peers, as well as from the wider public. Examples of stigmatism experienced included physical avoidance from neighbours and community members when the HCP travelled to and from and around their home, especially when dwellings were in shared buildings and common areas.

“My house owner avoided talking and meeting me because I worked with COVID patients.” [N]. “I have an elderly family member, and I was afraid and worried [for them] when I came back from duty.” [N].

Interviewees described how rumours would spread within the community, notably related to concerns of risk of co-infection or cross-infection, either directly from parent to child or indirectly via friends and extended family. Some HCPs were asked or elected to stay away from their home so as to reduce the stigma to them and their family and in an attempt to reduce the risk of co-infection, particularly when they had vulnerable family members. Interviewees described how this self-selected or enforced separation and isolation resulted in feelings of rejection, physically and emotionally heightened feelings of stress and anxiety, alongside the threat to physical and emotional safety.

Physical and emotional safety

Increased workload and an enforced change in working pattern/ shift structures were experienced by all the HCPs interviewed. These longer overall working hours, increased duration of shift patterns, and enforced working rotas were perceived as resulting in a loss of physical and emotional safety by the interviewees. Feelings of loss of control, insomnia, or disruption to sleep patterns, alongside physical discomfort through sustained working in personal protective equipment, often in hot and humid temperatures. This physical and mental endurance contributed to feelings of emotional stress and anxiety.

“Shift frequency was increased, and I only got one night off in a week. Sometimes I had to work extra hours, which was very stressful.” [N]. “My sleep pattern had changed, I felt restless and was afraid about COVID” [D].

The change in shift structure and in working patterns meant for some HCPs enforced separation from family and friends whereby HCPs sought accommodation away from family or in temporary lodgings. This again resulted in isolation and additional strain on other family members so as to provide care for HCP’s dependents.

“I had to involve other family members to arrange for the medication and care of my grandmother” [N].

Increased working hours and changes in working patterns further had physical impacts; participants described skipping meals or having limited time to eat. The need to wear personal protective equipment (PPE), and indeed the risks to safety when PPE was not available, associated risks of non-availability of equipment, brought with it a risk to physical and emotional safety. HCPs interviewed reported skin lacerations, irritation, and discomfort whilst wearing equipment in hot, humid working environments.

“We had to frequently change the PPE and masks, which has caused skin problems that still exist.” [N].

Organisational support

Interviewees found the COVID-19 pandemic brought new and often enforced work responsibilities, some of which were associated with high levels of professional anxiety, stress, and uncertainty. A professionally challenging situation, even for those with many years of ICU working experience. HCPs faced emotionally challenging tasks such as dealing with end-of-life situations (particularly without relatives of the patient present) and having to comfort relatives over the phone, of which they received limited to no training or support on handling such situations.

“I went through an emotional breakdown while dealing with the end of the life situation of patients without the presence of family members in the COVID ICU… I felt sad when a young patient lost their lives” [D]. “Accommodation or isolation facilities should be provided by the hospital” [D]. “If incentives were provided in time and staff were provided with health insurance it would motivate us” [N].

Ever-changing role and responsibilities created anxiety for HCPs as to what care to deliver, and the rapidity and uncertainty of care were associated with feelings of vulnerability. Interviewees expressed how they wished there was a need for greater organisational support to better cope with the frequent updates and changes to practice. Furthermore, HCPs expressed concerns regarding a shortage of staff and the lack of mental health counselling and support, accommodation on-site at the hospital, and transportation to and from work.

“Mental health support or counselling facilities were not provided. It should be there… seniors and hospital staff should also talk to the staff to know the situation.” [N]. “Safety of healthcare workers should be the priority and nurse-patient ratio should be maintained to provide quality care to the patients… hospital should have recruited more staff.” [N].

Coping strategies

Participants described various ways in which they coped with the emotional, physical, social, and professional impacts of working through the pandemic. This included speaking with family and friends about the pressures they were under, taking up activities in their off time, such as gardening and reading, and using media entertainment such as music, movies, and shows. A few participants also mentioned that comparing the situation in Nepal to other countries (i.e., keeping up-to-date with the news) also helped them cope. Others mentioned that detachment from social media and more self-awareness through meditation helped.

“I ventilated my feelings with friends and family. Listening to soothing music also helped me cope with the stress.” [N]. “I coped by gardening with my sister in my home.” [N]. “I… watched the news that compared the death rates, which was low compared to others.” [D].

The COVID-19 pandemic’s impact on healthcare services and population health internationally is unprecedented in recent times. As healthcare professionals, policymakers, and researchers work to strengthen services in preparation for future pandemics now and mitigate the long-term impacts on individual and population health, understanding the impact on and perspectives of doctors and nurses at the frontline of care can provide important learning regarding the individuals characteristics and professional, social and economic drivers which may increase the risk of psychological impacts.

Mandated and enforced changes in role, specifically in working hours and shift patterns, were a key driver of psychological anxiety and distress. Within hospitals in Nepal, many departments were closed, and stay-at-home orders meant that outpatient or clinical services all but ceased. This resulted in an increased role and scope for critical care trained staff, and in contrast to other health systems (such as the UK) where healthcare staff were redeployed to ICU, there was a separation for ICU staff even from their professional peers working in other specialties. The increased scope and uncertainty of the HCP’s role, along with limited choice in redeployment in the ICU was another driver of poor mental health- and dominated nursing participants’ experiences. Interviewees described how these changes impacted not only themselves but the multigenerational families for whom many cared for. This enforcement of role change, and the related descriptions of the drivers for these impacts as experienced by participants in this study point not only to the differences in roles between nurses and doctors; but also highlights disparities in autonomy, advocacy for role change during international emergencies, and the implications of work on home and family life [ 36 ].

Giving staff choice to select shift patterns and ensuring the opportunity to have periods of rest to reconnect with family and have self-care is needed. Consultation and shared decision-making, even in times of restricted choice, are associated with improved perceptions of work from staff and may result in reducing psychological distress and promoting emotional safety, which is, in turn, associated with better outcomes for patients [ 37 , 38 ]. However, nurses in Nepal, as with many health systems, may have less opportunity for strategic and organisational decision making in response to public health emergencies. The impact of ongoing disparities between professionals and their agency to advocate for wellbeing and safety warrants further research.

Nurses were disproportionately burdened by both occurrence and severity of symptoms of anxiety and depression as a result of their work during the pandemic when compared to doctors.

Nearly half of all respondents had symptoms of anxiety and PTSD (again more prevalent in nurses), and the burden of anxiety symptoms was higher than the reported 22–33% from a recent umbrella review [ 39 ]. The burden of stress we report was also higher than a smaller study conducted in Nepal during the pandemic, which reported stress among 53.2% of healthcare professionals working in hospitals, primary health centres, pharmacies, and health posts in Nepal [ 40 ]; it was also higher than a meta-analysis of published studies exploring the incidence of both stress (57%) and PTSD (22%) among all cadres of healthcare workers [ 41 ]. One reason for the higher reported symptoms in our study may be the focus on ICU workers and their role in the management of end-of-life care. Indeed, our results for depression and anxiety are comparable to a study involving nurses working directly with COVID-19 in Nepal [ 13 ]. Studies conducted elsewhere in Asia have highlighted this positive relationship between ICU experiences and poor mental health [ 42 ].

Nurses in Nepal, as with many other countries, are more likely to be female, younger in age, and have less opportunity for graduate study; and have lower earning potential than physician colleagues [ 43 ]; all characteristics associated with increased risk of poorer mental health outcomes [ 44 ]. Exploration into the disparities of the psychological and health impacts of COVID-19 on different cadres of healthcare workers is emerging. A systematic review conducted in 2020, identified 27 studies which sought to explore the disparity in impacts of the pandemic on HCP’s psychological well-being. The findings from the review are in line with ours, indicating that the burden of symptoms for anxiety, depression, and PTSD is higher in nurses compared to doctors [ 45 ]. Notably only a few of these studies used validated tools for assessment of specific symptoms of anxiety, depression, or substance misuse [ 45 ]. Our study serves to strengthen the evidence of the vulnerability of nurses.

Nepal, like many other lower and middle-income countries in South and Southeast Asia, enforced large-scale lockdowns and restrictions of movement for all but essential healthcare and municipal staff [ 46 ]. As such, social stigmatism, physical and emotional safety, and organisational support were key drivers behind the elevated symptoms of psychological distress in ICU HCPs and may be a key determinant of differences between health systems internationally. Furthermore, the family responsibilities and social circumstances for nurses, contributed to their experiences of isolation, rejection, vulnerability, physical discomfort, and strain. These drivers mirrored those reported from Europe; and may reflect differences experienced by nurses as a result of their gender, and role norms of primary family carers within society [ 44 ].

Interviewees from both professional groups expressed concern at the absence of preparedness and support they felt from their employing institutions. This is notable given the ongoing investment in pandemic preparedness and the potential to make changes now to prepare for the next pandemic or public health emergency. Interventions such as resilience training, scenario-based simulation training, and group exercises based on psychoeducation and cognitive behavioural therapy (CBT) principles have proved effective in reducing anxiety, depression, stress, and PTSD among doctors and nurses while simultaneously improving their ability to work in unprecedented situations in other sectors [ 47 ]. Similar provisions may be valuable for ICU-based healthcare professionals and are deliverable online, making rollout potentially more feasible.

Strengths and limitations

A strength of this study is the exploration of participants’ perspectives on the drivers behind the burden of poor mental health described in ICU HCPs. This mixed methods approach offers insights into doctors’ and nurses’ unique individual, social and professional characteristics that may be associated with increased risk of distress. These differences and their potential for disparity in impacts on health and wellbeing should be of interest to policymakers and healthcare facility managers involved in future pandemic preparedness. However, the study has some limitations to acknowledge. Given the use of the snowball technique, we were able to ensure a high number of respondents, but as a consequence, we were unable to track the number of respondents that came from using this technique compared to those initially invited from the NSCCM and CCNAN. Therefore, a response rate and, subsequently, a non-response rate could not be reported. We did not collect information on the level of training in critical care that participants received; trained health professionals are likely to have additional skills in how to handle the potential stressful environment in critical care settings. Also, due to the lack of validation of the PCL-5 in Nepal, the results of this assessment tool should be interpreted with caution. The survey tools used for this study have not been validated in an online format. However, given these tools were self-reporting, and were piloted and administered in English, the online format is thought to have minimal impact on the results. Additionally, participants for the qualitative component were recruited based on convenience sampling; therefore, the diversity of the sample may not be optimised. We acknowledge that recall bias may be present in the participants during the interview, given they were recalling their experiences throughout the pandemic for up to 24 months prior to the interview; however, we hope the piloting of the interviews, the use of multiple researchers to code the data, and the constant comparative nature of the evaluation will mitigate this potential.

The COVID-19 pandemic negatively impacted the mental health of HCPs worldwide. This study strengthens existing evidence that nurses were (and may remain) at increased risk of both cross infection and may also be more vulnerable to psychological impacts including anxiety, depression and PTSD than their professional colleagues. In addition, critical care staff may be at even greater risk, due to the uniqueness of their role which includes prolonged periods of time with infected patients, frontline role in managing end of life care, and as described here, limited ability to advocate for changing role and working patterns during an emergency. Professional hierarchies, and social-economic and gender profiles unique to nurses, may be potential drivers for these disparities, and warrants further research. Learning from the ICU HCPs’ experiences during the COVID-19 pandemic may inform future preparedness strategies e to mitigate short and long-term mental illness among ICU HCPs in future pandemics.

Data availability

The interview guide is available in the Figshare repository,

https://doi.org/10.6084/m9.figshare.24247384.v1 .

The data supporting the conclusions of this article are available in the Figshare repository, https://doi.org/10.6084/m9.figshare.23999790.v1 .

Abbreviations

Coronavirus disease 2019

Intensive care unit

Healthcare professional

Personal protective equipment

Post-traumatic stress disorder

Nepalese Society of Critical Care Medicine

Critical Care Nurses Association of Nepal

Beck Anxiety Inventory

Beck Depression Inventory

Perceived Stress Scale

PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5

Alcohol Use Disorder Identification Tool

Rapid assessment procedure

Cognitive behavioural therapy

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Acknowledgements

We thank the volunteers who took the time to interview the participants: Radhika Maharjan, Dipika Khadka, Anita Bashyal, Samina Amatya, and Roshani Kafle. We also want to thank Dr. Rohini Nepal and Jugmaya Chaudhary of Rhythm Neuropsychiatry Hospital and Research Centre for their contribution to advising and reviewing the self-reporting psychological assessment tools used in the questionnaire. We would also like to thank Transcultural Psychosocial Organisation (TPO) Nepal and Dr. Nabaraj Koirala for the permission to use the Nepali-validated version of BDI I and BAI for the study. We additionally thank Nilu Dullewe, who helped in coding the qualitative data. For the ongoing mutual support for improvements in ICU care, we would also like to acknowledge and thank members of the CCAA.

CCAA members

Diptesh Aryal, Shirish KC, Kanchan Koirala, Subekshya Luitel, Rohini Nepal, Sushil Khanal, Hem R Paneru, Subha K Shreshta, Sanjay Lakhey, Samina Amatya, Kaveri Thapa, Radhika Maharjan, Roshani Kafle, Anita Bashyal, Reema Shrestha, Dipika Khadka and Nilu Dullewe.

This study was funded by a Wellcome Innovations Flagship Programme grant (Wellcome grant number: 215522/Z/19/Z). They had no role in the design, analysis, or reporting of this protocol.

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Nepal Intensive Care Research Foundation, Kathmandu, Nepal

Shirish KC, Diptesh Aryal, Kanchan Koirala & Subekshya Luitel

Institute of Applied Health Research, University of Birmingham, Birmingham, UK

Tiffany E. Gooden

Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK

Rashan Haniffa & Abi Beane

Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand

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• Diptesh Aryal
• , Shirish KC
• , Kanchan Koirala
• , Subekshya Luitel
• , Rohini Nepal
• , Sushil Khanal
• , Hem R Paneru
• , Subha K Shreshta
• , Sanjay Lakhey
• , Samina Amatya
• , Kaveri Thapa
• , Radhika Maharjan
• , Roshani Kafle
• , Anita Bashyal
• , Reema Shrestha
• , Dipika Khadka
•  & Nilu Dullewe

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All authors conceptualised this study. SK, DA, AB, RH, and SL developed the protocol, study methods, and materials. KK and SL facilitated the data collection, supervised by SK and DA. Data were analysed by SK, AB, KK, and TEG. SK and TEG wrote the drafts of the manuscript, and all authors reviewed the manuscript and consented to it being submitted. AB is the senior author.

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Correspondence to Diptesh Aryal .

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Ethics approval was granted from the Nepal Health Research Council (approval number: 176/2021 P). All participants provided informed consent electronically before completing the online questionnaire. Participants from the qualitative component provided further informed verbal consent before the interview commenced.

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KC, S., Gooden, T.E., Aryal, D. et al. The burden of anxiety, depression, and stress, along with the prevalence of symptoms of PTSD, and perceptions of the drivers of psychological harms, as perceived by doctors and nurses working in ICUs in Nepal during the COVID-19 pandemic; a mixed method evaluation. BMC Health Serv Res 24 , 450 (2024). https://doi.org/10.1186/s12913-024-10724-7

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The Effect of COVID-19 on Education

Jacob hoofman.

a Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201, USA

Elizabeth Secord

b Department of Pediatrics, Wayne Pediatrics, School of Medicine, Pediatrics Wayne State University, 400 Mack Avenue, Detroit, MI 48201, USA

COVID-19 has changed education for learners of all ages. Preliminary data project educational losses at many levels and verify the increased anxiety and depression associated with the changes, but there are not yet data on long-term outcomes. Guidance from oversight organizations regarding the safety and efficacy of new delivery modalities for education have been quickly forged. It is no surprise that the socioeconomic gaps and gaps for special learners have widened. The medical profession and other professions that teach by incrementally graduated internships are also severely affected and have had to make drastic changes.

• • Virtual learning has become a norm during COVID-19.
• • Children requiring special learning services, those living in poverty, and those speaking English as a second language have lost more from the pandemic educational changes.
• • For children with attention deficit disorder and no comorbidities, virtual learning has sometimes been advantageous.
• • Math learning scores are more likely to be affected than language arts scores by pandemic changes.
• • School meals, access to friends, and organized activities have also been lost with the closing of in-person school.

The transition to an online education during the coronavirus disease 2019 (COVID-19) pandemic may bring about adverse educational changes and adverse health consequences for children and young adult learners in grade school, middle school, high school, college, and professional schools. The effects may differ by age, maturity, and socioeconomic class. At this time, we have few data on outcomes, but many oversight organizations have tried to establish guidelines, expressed concerns, and extrapolated from previous experiences.

General educational losses and disparities

Many researchers are examining how the new environment affects learners’ mental, physical, and social health to help compensate for any losses incurred by this pandemic and to better prepare for future pandemics. There is a paucity of data at this juncture, but some investigators have extrapolated from earlier school shutdowns owing to hurricanes and other natural disasters. 1

Inclement weather closures are estimated in some studies to lower middle school math grades by 0.013 to 0.039 standard deviations and natural disaster closures by up to 0.10 standard deviation decreases in overall achievement scores. 2 The data from inclement weather closures did show a more significant decrease for children dependent on school meals, but generally the data were not stratified by socioeconomic differences. 3 , 4 Math scores are impacted overall more negatively by school absences than English language scores for all school closures. 4 , 5

The Northwest Evaluation Association is a global nonprofit organization that provides research-based assessments and professional development for educators. A team of researchers at Stanford University evaluated Northwest Evaluation Association test scores for students in 17 states and the District of Columbia in the Fall of 2020 and estimated that the average student had lost one-third of a year to a full year's worth of learning in reading, and about three-quarters of a year to more than 1 year in math since schools closed in March 2020. 5

With school shifted from traditional attendance at a school building to attendance via the Internet, families have come under new stressors. It is increasingly clear that families depended on schools for much more than math and reading. Shelter, food, health care, and social well-being are all part of what children and adolescents, as well as their parents or guardians, depend on schools to provide. 5 , 6

Many families have been impacted negatively by the loss of wages, leading to food insecurity and housing insecurity; some of loss this is a consequence of the need for parents to be at home with young children who cannot attend in-person school. 6 There is evidence that this economic instability is leading to an increase in depression and anxiety. 7 In 1 survey, 34.71% of parents reported behavioral problems in their children that they attributed to the pandemic and virtual schooling. 8

Children have been infected with and affected by coronavirus. In the United States, 93,605 students tested positive for COVID-19, and it was reported that 42% were Hispanic/Latino, 32% were non-Hispanic White, and 17% were non-Hispanic Black, emphasizing a disproportionate effect for children of color. 9 COVID infection itself is not the only issue that affects children’s health during the pandemic. School-based health care and school-based meals are lost when school goes virtual and children of lower socioeconomic class are more severely affected by these losses. Although some districts were able to deliver school meals, school-based health care is a primary source of health care for many children and has left some chronic conditions unchecked during the pandemic. 10

Many families report that the stress of the pandemic has led to a poorer diet in children with an increase in the consumption of sweet and fried foods. 11 , 12 Shelter at home orders and online education have led to fewer exercise opportunities. Research carried out by Ammar and colleagues 12 found that daily sitting had increased from 5 to 8 hours a day and binge eating, snacking, and the number of meals were all significantly increased owing to lockdown conditions and stay-at-home initiatives. There is growing evidence in both animal and human models that diets high in sugar and fat can play a detrimental role in cognition and should be of increased concern in light of the pandemic. 13

The family stress elicited by the COVID-19 shutdown is a particular concern because of compiled evidence that adverse life experiences at an early age are associated with an increased likelihood of mental health issues as an adult. 14 There is early evidence that children ages 6 to 18 years of age experienced a significant increase in their expression of “clinginess, irritability, and fear” during the early pandemic school shutdowns. 15 These emotions associated with anxiety may have a negative impact on the family unit, which was already stressed owing to the pandemic.

Another major concern is the length of isolation many children have had to endure since the pandemic began and what effects it might have on their ability to socialize. The school, for many children, is the agent for forming their social connections as well as where early social development occurs. 16 Noting that academic performance is also declining the pandemic may be creating a snowball effect, setting back children without access to resources from which they may never recover, even into adulthood.

Predictions from data analysis of school absenteeism, summer breaks, and natural disaster occurrences are imperfect for the current situation, but all indications are that we should not expect all children and adolescents to be affected equally. 4 , 5 Although some children and adolescents will likely suffer no long-term consequences, COVID-19 is expected to widen the already existing educational gap from socioeconomic differences, and children with learning differences are expected to suffer more losses than neurotypical children. 4 , 5

Special education and the COVID-19 pandemic

Although COVID-19 has affected all levels of education reception and delivery, children with special needs have been more profoundly impacted. Children in the United States who have special needs have legal protection for appropriate education by the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act of 1973. 17 , 18 Collectively, this legislation is meant to allow for appropriate accommodations, services, modifications, and specialized academic instruction to ensure that “every child receives a free appropriate public education . . . in the least restrictive environment.” 17

Children with autism usually have applied behavioral analysis (ABA) as part of their individualized educational plan. ABA therapists for autism use a technique of discrete trial training that shapes and rewards incremental changes toward new behaviors. 19 Discrete trial training involves breaking behaviors into small steps and repetition of rewards for small advances in the steps toward those behaviors. It is an intensive one-on-one therapy that puts a child and therapist in close contact for many hours at a time, often 20 to 40 hours a week. This therapy works best when initiated at a young age in children with autism and is often initiated in the home. 19

Because ABA workers were considered essential workers from the early days of the pandemic, organizations providing this service had the responsibility and the freedom to develop safety protocols for delivery of this necessary service and did so in conjunction with certifying boards. 20

Early in the pandemic, there were interruptions in ABA followed by virtual visits, and finally by in-home therapy with COVID-19 isolation precautions. 21 Although the efficacy of virtual visits for ABA therapy would empirically seem to be inferior, there are few outcomes data available. The balance of safety versus efficacy quite early turned to in-home services with interruptions owing to illness and decreased therapist availability owing to the pandemic. 21 An overarching concern for children with autism is the possible loss of a window of opportunity to intervene early. Families of children and adolescents with autism spectrum disorder report increased stress compared with families of children with other disabilities before the pandemic, and during the pandemic this burden has increased with the added responsibility of monitoring in-home schooling. 20

Early data on virtual schooling children with attention deficit disorder (ADD) and attention deficit with hyperactivity (ADHD) shows that adolescents with ADD/ADHD found the switch to virtual learning more anxiety producing and more challenging than their peers. 22 However, according to a study in Ireland, younger children with ADD/ADHD and no other neurologic or psychiatric diagnoses who were stable on medication tended to report less anxiety with at-home schooling and their parents and caregivers reported improved behavior during the pandemic. 23 An unexpected benefit of shelter in home versus shelter in place may be to identify these stressors in face-to-face school for children with ADD/ADHD. If children with ADD/ADHD had an additional diagnosis of autism or depression, they reported increased anxiety with the school shutdown. 23 , 24

Much of the available literature is anticipatory guidance for in-home schooling of children with disabilities rather than data about schooling during the pandemic. The American Academy of Pediatrics published guidance advising that, because 70% of students with ADHD have other conditions, such as learning differences, oppositional defiant disorder, or depression, they may have very different responses to in home schooling which are a result of the non-ADHD diagnosis, for example, refusal to attempt work for children with oppositional defiant disorder, severe anxiety for those with depression and or anxiety disorders, and anxiety and perseveration for children with autism. 25 Children and families already stressed with learning differences have had substantial challenges during the COVID-19 school closures.

High school, depression, and COVID-19

High schoolers have lost a great deal during this pandemic. What should have been a time of establishing more independence has been hampered by shelter-in-place recommendations. Graduations, proms, athletic events, college visits, and many other social and educational events have been altered or lost and cannot be recaptured.

Adolescents reported higher rates of depression and anxiety associated with the pandemic, and in 1 study 14.4% of teenagers report post-traumatic stress disorder, whereas 40.4% report having depression and anxiety. 26 In another survey adolescent boys reported a significant decrease in life satisfaction from 92% before COVID to 72% during lockdown conditions. For adolescent girls, the decrease in life satisfaction was from 81% before COVID to 62% during the pandemic, with the oldest teenage girls reporting the lowest life satisfaction values during COVID-19 restrictions. 27 During the school shutdown for COVID-19, 21% of boys and 27% of girls reported an increase in family arguments. 26 Combine all of these reports with decreasing access to mental health services owing to pandemic restrictions and it becomes a complicated matter for parents to address their children's mental health needs as well as their educational needs. 28

A study conducted in Norway measured aspects of socialization and mood changes in adolescents during the pandemic. The opportunity for prosocial action was rated on a scale of 1 (not at all) to 6 (very much) based on how well certain phrases applied to them, for example, “I comforted a friend yesterday,” “Yesterday I did my best to care for a friend,” and “Yesterday I sent a message to a friend.” They also ranked mood by rating items on a scale of 1 (not at all) to 5 (very well) as items reflected their mood. 29 They found that adolescents showed an overall decrease in empathic concern and opportunity for prosocial actions, as well as a decrease in mood ratings during the pandemic. 29

A survey of 24,155 residents of Michigan projected an escalation of suicide risk for lesbian, gay, bisexual, transgender youth as well as those youth questioning their sexual orientation (LGBTQ) associated with increased social isolation. There was also a 66% increase in domestic violence for LGBTQ youth during shelter in place. 30 LGBTQ youth are yet another example of those already at increased risk having disproportionate effects of the pandemic.

Increased social media use during COVID-19, along with traditional forms of education moving to digital platforms, has led to the majority of adolescents spending significantly more time in front of screens. Excessive screen time is well-known to be associated with poor sleep, sedentary habits, mental health problems, and physical health issues. 31 With decreased access to physical activity, especially in crowded inner-city areas, and increased dependence on screen time for schooling, it is more difficult to craft easy solutions to the screen time issue.

During these times, it is more important than ever for pediatricians to check in on the mental health of patients with queries about how school is going, how patients are keeping contact with peers, and how are they processing social issues related to violence. Queries to families about the need for assistance with food insecurity, housing insecurity, and access to mental health services are necessary during this time of public emergency.

Medical school and COVID-19

Although medical school is an adult schooling experience, it affects not only the medical profession and our junior colleagues, but, by extrapolation, all education that requires hands-on experience or interning, and has been included for those reasons.

In the new COVID-19 era, medical schools have been forced to make drastic and quick changes to multiple levels of their curriculum to ensure both student and patient safety during the pandemic. Students entering their clinical rotations have had the most drastic alteration to their experience.

COVID-19 has led to some of the same changes high schools and colleges have adopted, specifically, replacement of large in-person lectures with small group activities small group discussion and virtual lectures. 32 The transition to an online format for medical education has been rapid and impacted both students and faculty. 33 , 34 In a survey by Singh and colleagues, 33 of the 192 students reporting 43.9% found online lectures to be poorer than physical classrooms during the pandemic. In another report by Shahrvini and colleagues, 35 of 104 students surveyed, 74.5% students felt disconnected from their medical school and their peers and 43.3% felt that they were unprepared for their clerkships. Although there are no pre-COVID-19 data for comparison, it is expected that the COVID-19 changes will lead to increased insecurity and feelings of poor preparation for clinical work.

Gross anatomy is a well-established tradition within the medical school curriculum and one that is conducted almost entirely in person and in close quarters around a cadaver. Harmon and colleagues 36 surveyed 67 gross anatomy educators and found that 8% were still holding in-person sessions and 34 ± 43% transitioned to using cadaver images and dissecting videos that could be accessed through the Internet.

Many third- and fourth-year medical students have seen periods of cancellation for clinical rotations and supplementation with online learning, telemedicine, or virtual rounds owing to the COVID-19 pandemic. 37 A study from Shahrvini and colleagues 38 found that an unofficial document from Reddit (a widely used social network platform with a subgroup for medical students and residents) reported that 75% of medical schools had canceled clinical activities for third- and fourth-year students for some part of 2020. In another survey by Harries and colleagues, 39 of the 741 students who responded, 93.7% were not involved in clinical rotations with in-person patient contact. The reactions of students varied, with 75.8% admitting to agreeing with the decision, 34.7% feeling guilty, and 27.0% feeling relieved. 39 In the same survey, 74.7% of students felt that their medical education had been disrupted, 84.1% said they felt increased anxiety, and 83.4% would accept the risk of COVID-19 infection if they were able to return to the clinical setting. 39

Since the start of the pandemic, medical schools have had to find new and innovative ways to continue teaching and exposing students to clinical settings. The use of electronic conferencing services has been critical to continuing education. One approach has been to turn to online applications like Google Hangouts, which come at no cost and offer a wide variety of tools to form an integrative learning environment. 32 , 37 , 40 Schools have also adopted a hybrid model of teaching where lectures can be prerecorded then viewed by the student asynchronously on their own time followed by live virtual lectures where faculty can offer question-and-answer sessions related to the material. By offering this new format, students have been given more flexibility in terms of creating a schedule that suits their needs and may decrease stress. 37

Although these changes can be a hurdle to students and faculty, it might prove to be beneficial for the future of medical training in some ways. Telemedicine is a growing field, and the American Medical Association and other programs have endorsed its value. 41 Telemedicine visits can still be used to take a history, conduct a basic visual physical examination, and build rapport, as well as performing other aspects of the clinical examination during a pandemic, and will continue to be useful for patients unable to attend regular visits at remote locations. Learning effectively now how to communicate professionally and carry out telemedicine visits may better prepare students for a future where telemedicine is an expectation and allow students to learn the limitations as well as the advantages of this modality. 41

Pandemic changes have strongly impacted the process of college applications, medical school applications, and residency applications. 32 For US medical residencies, 72% of applicants will, if the pattern from 2016 to 2019 continues, move between states or countries. 42 This level of movement is increasingly dangerous given the spread of COVID-19 and the lack of currently accepted procedures to carry out such a mass migration safely. The same follows for medical schools and universities.

We need to accept and prepare for the fact that medial students as well as other learners who require in-person training may lack some skills when they enter their profession. These skills will have to be acquired during a later phase of training. We may have less skilled entry-level resident physicians and nurses in our hospitals and in other clinical professions as well.

The COVID-19 pandemic has affected and will continue to affect the delivery of knowledge and skills at all levels of education. Although many children and adult learners will likely compensate for this interruption of traditional educational services and adapt to new modalities, some will struggle. The widening of the gap for those whose families cannot absorb the teaching and supervision of education required for in-home education because they lack the time and skills necessary are not addressed currently. The gap for those already at a disadvantage because of socioeconomic class, language, and special needs are most severely affected by the COVID-19 pandemic school closures and will have the hardest time compensating. As pediatricians, it is critical that we continue to check in with our young patients about how they are coping and what assistance we can guide them toward in our communities.

Clinics care points

• • Learners and educators at all levels of education have been affected by COVID-19 restrictions with rapid adaptations to virtual learning platforms.
• • The impact of COVID-19 on learners is not evenly distributed and children of racial minorities, those who live in poverty, those requiring special education, and children who speak English as a second language are more negatively affected by the need for remote learning.
• • Math scores are more impacted than language arts scores by previous school closures and thus far by these shutdowns for COVID-19.
• • Anxiety and depression have increased in children and particularly in adolescents as a result of COVID-19 itself and as a consequence of school changes.
• • Pediatricians should regularly screen for unmet needs in their patients during the pandemic, such as food insecurity with the loss of school meals, an inability to adapt to remote learning and increased computer time, and heightened anxiety and depression as results of school changes.

The authors have nothing to disclose.