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 Table of Contents  
Year : 2023  |  Volume : 11  |  Issue : 1  |  Page : 81-87

Distance learning environment: Perception of medical students using the Distance Education Learning Environments Survey in a tertiary care teaching hospital

1 Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
2 Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
3 Department of Pharmacology, Government Medical College, Akola, Maharashtra, India
4 Department of Biochemistry, Nandkumar Singh Chouhan Government Medical College, Khandwa, Madhya Pradesh, India
5 Department of Anesthesiology, Nandkumar Singh Chouhan Government Medical College, Khandwa, Madhya Pradesh, India

Date of Submission06-Jul-2022
Date of Decision15-Jul-2022
Date of Acceptance06-Sep-2022
Date of Web Publication02-Feb-2023

Correspondence Address:
Uditkumar Agrawal
Department of Biochemistry, Nandkumar Singh Chouhan Government Medical College, Khandwa, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjhs.mjhs_43_22

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Background: Amid the COVID-19 period and lockdowns, medical education has witnessed major changes. Shifting from face-to-face offline education to online education in such an important branch of education dealing with human lives and serving mankind is really very challenging. In this distance learning process, student satisfaction is important and prediction of their satisfaction and other important parameters will help in improving the online system of medical education.
Objective: To evaluate students' perception about distance learning education based on different domains given in the Distance learning Education Environment survey scale.
Materials and Methods: A cross-sectional study was conducted among first-year and final-year MBBS students of the Institute of Medical Sciences, BHU. The total number of students who participated in the study was 123. The Distance Education Learning Environments Survey (DELES) scale which was validated for higher education by Scott L was used. The domain represents instructor support (D1), student interaction and collaboration (D2), personal relevance (D3), authentic learning (D4), active learning (D5), student autonomy (D6), and student satisfaction in distance learning process (D7).
Results: The mean and standard deviation for each domain of the DELES were calculated. For instructor support, the mean was 25.9 for first-year students and 21.3 for final-year students. For the domain of authentic learning, the mean score was low, i.e. 15.7, for the first year and 13.3 for the final year. In the learning domain for the question about students satisfaction, the mean score was 19.8 for first-year students and 17.9 for final-year students.
Conclusion: The finding of this study indicated that the majority of students were satisfied with instructor's support and personal relevance of the online learning classes, but were unsatisfied with opportunities of student interaction and group discussion, which is essential in medical education.

Keywords: COVID period, Distance Education Learning Environments Survey questionnaire, distance learning environment, medical education

How to cite this article:
Giri KR, Palandurkar KM, Giri R, Agrawal U, Agrawal S. Distance learning environment: Perception of medical students using the Distance Education Learning Environments Survey in a tertiary care teaching hospital. MRIMS J Health Sci 2023;11:81-7

How to cite this URL:
Giri KR, Palandurkar KM, Giri R, Agrawal U, Agrawal S. Distance learning environment: Perception of medical students using the Distance Education Learning Environments Survey in a tertiary care teaching hospital. MRIMS J Health Sci [serial online] 2023 [cited 2023 Mar 30];11:81-7. Available from: http://www.mrimsjournal.com/text.asp?2023/11/1/81/369042

  Introduction Top

Amid the COVID-19 period and lockdowns, medical education has witnessed major changes. Medical education has always been clinical practice-based and patient-centered education. Shifting from face-to-face offline education to online education in such an important branch of education dealing with human lives and serving mankind is really very challenging.[1] In this distance learning process, student satisfaction is important and prediction of their satisfaction and other important parameters will help in improving the online system of medical education, so that in future, both the systems offline and online can coexist with their benefits to the students at large.[2],[3] Distant learning environment survey is a tool which is made to analyze different parameters of student satisfaction like instructor support, students interaction, personal relevance, authentic learning, active learning, student autonomy, and distance learning.[4]

Technology has faced a major change in the decade, learning that technology and applying them for the benefit of the students is important.[5] Along with instructors, students also should keep pace with the challenges of technology. Face-to-face teaching has major advantages as the teacher can assess the understanding and satisfaction by interaction and answer their queries at that time of lectures only.[6] Teachers also make sure that students will remain attentive during class. There is no need for high-end tools for offline teaching. Online teaching came with many challenges such as the availability of the Internet and the availability of online teaching platforms such as Google Classroom, telemedicine classroom, and proper devices so that students attend the long learning session with minimal discomfort.[7] Continuation of education in the ever-changing field of medical education is of utmost importance. In this challenging time of COVID, online education played a very important role. It is very important that when using the new online system of education, we all take efforts to talk about every single aspect of student satisfaction. In any type of education, interaction and improvement play a very important role, so that we cultivate an environment of the impressive, futuristic student-centered online education system.[8] Learning approaches have been divided into the surface approach, the profound approach, and the strategic approach. In the surface approach, students concentrate on assessment requirements. In a profound approach, students connect knowledge to its implication and practice. In a strategic approach, students use the best of two approaches (surface and profound) to achieve their goal. To develop any specific approach, student understanding plays a very important role. These types of assessments help us make a building block for future education. It is very important to know the student's point of view and change the strategy of online education accordingly.[9],[10]

Using recourses effectively also plays a very important role in online education; different tools are available such as Jamboard, Whiteboard, and OpenBoard software. Course content development and its effective delivery is an art and needs continuous efforts to improve. To make online medical education dynamic, interesting, and interactive, effective online teaching is important. There has been a transformative change in medical education in this unprecedented time. It is important to assess the impact of the COVID period on medical education in India.[2]

Clinical rotations are an integral part of medical education, students learn a lot during their clinical rotation in different departments, and they interact with patients and develop the art of history taking and accurate diagnosis. COVID period has changed the face of clinical posting, and now, instructors are discussing clinical cases online, but it is important to know whether this type of learning is helpful or not; hence, in this study, we have compared two focus groups of MBBS, i.e. first year and final year.[11]

The objective of the current study was to evaluate students' perceptions about distance learning based on different domains given in the Distance learning Education Environment survey.

  Materials and Methods Top

A cross-sectional observational study was conducted on first-year and final-year MBBS students. The total number of students who participated in the study was 123. The study was conducted at the Institute of Medical Sciences, Banaras Hindu University.

After describing the ethical implications of the project to the participants, including the consistency and fairness of the studies, regard for confidentiality and privacy, and the independent existence of the study, online informed consent was received from each participant. The ethical committee permission was taken, letter no. Dean/2020/EC/2097. The structured Google Forms was prepared based on the Distance learning Education Environment survey scale and circulated to those students who were attending online classes. The language of the scale was English. The link to the Google Forms was sent to all the students through batch E-mail and the common WhatsApp group. The study started on December 1, 2020. The link was disabled after 7 days. The sampling technique used was snowball sampling. All those who consented were included in the study. The team received 123 responses, among them 25 responses were incomplete. The total duration of the study period was 3 months after receiving ethical approval.

All the students attending online classes among first-year and final-year MBBS, who gave consent, were included in the study. Those students who did not give consent were excluded from the study.

Brief demographic information was asked and an electronic version of the questionnaires was sent and requested to be filled by the participants: the Distance Education Learning Environments Survey (DELES) questionnaire. The DELES scale which was validated for higher education by Walker and Fraser was used.[4] The DELES survey consisted of a total of 42 Likert statements that focused on seven domain areas with a specific number of statements related to each domain. There were 8 statements related to instructor support (D1), 6 for student interaction and collaboration (D2), 7 for personal relevance (D3), 5 for authentic learning (D4), 3 for active learning (D5), 5 for student autonomy (D6), and 8 for student satisfaction in distance learning process (D7). The responses were coded for analysis: 1 = never, 2 = seldom, 3 = sometimes, 4 = often, and 5 = always. For each of the DELES domains, the total value was calculated from each student and recorded. The alpha reliability coefficient for the DELES scale was 0.961. The high alpha number indicates the group of statements that are related to the same domain. The reliability and validity of the results were obtained.

Data analyses were conducted using SPSS 26 (IBM SPSS Statistics). Descriptive analyses were conducted to present the student basic information and the average score of predictor variables and student satisfaction. Correlation analysis was performed to understand the relationship between the types of interactions and student satisfaction. An independent t-test was performed to investigate the effect of student background variables on the seven predictors.

  Results Top

The total number of students who participated in the study was 123, out of which 98 responses were completed and taken into consideration for statistical evaluation. The overall response rate was 81%: n = 48 for the first-year and n = 50 for final-year students. In the first-year students, 33.3% were female and 66.6 were male. The average age of students was 19.2 years. In the final-year students, 40% were female and 60% were male, and the average age of students was 23.1 years.

The reliability scoring of each domain was calculated and the score was between 0.74 to 0.92 for all the domains [Table 1].
Table 1: Reliability information for subscales

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The mean and standard deviation for each domain was calculated. For first-year students, the mean score ranged from 10.7 to 25.9. For final-year students, the mean score ranged between 9.1 and 21.3. The median score for each domain was calculated. The median score for the first year ranged from 11 to 28. For the final-year students, the median score ranged from 9 to 22. The minimum score recorded in the first year was 2, the minimum score recorded in the final year was 1, the maximum score recorded in the first year was 40, and the final year was 39 [Table 2]a and [Table 2]b. A low mean score of the individual question was noted and indicated those areas in which students are not satisfied and need improvement. The coefficient of correlation between domains and their statistical significance is shown in [Table 3].
Table 2: (a) Average scores in each domain, (b) Median score of each domain

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Table 3: Coefficient of correlation between domains and its statistical significance

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Overall, students were still adapting to the system of online education and were not satisfied with it as indicated by the mean score of questions 35–42 in both years. In the final year, students are not completely satisfied with the instructors' feedback and collaboration with other students in the class. This indicates the areas where improvements are needed.

  Discussion Top

Validation of different domains and consideration of students' perceptions play a very important role in building up guidelines and course work. Sharing views and measuring them with different scales help in widening the horizon of online learning and identifying learners' needs and formation of creative online learning designs.

There was not a predetermined selection factor based on any gender and age and they had equal chance of attending the question which reduces the potential bias of selection. Their results are more generalizable to the students of medical, dental, nursing, and the students of paramedical sciences and those having practical and communication skills in their curriculum than those students with more theoretical curriculum.

The involvement of students helps in active discussion and building up a cooperative learning environment.[12] In a study by Schlégl et al., they used an innovative method using available homemade tools to teach basic surgical skills to two students.[13]

In the present study, 25.9 was the mean for the first-year students in the domain of instructor support as compared to 21.3 for final-year students.

In a study by Dost et al., 59.73% of students affirmed that they got an opportunity to interact via chat box. It was also mentioned in the same study that 19.8 2% of students found that online teaching saves time on travelling (19.82%), provides flexibility (19.52%), the ability for students to learn at their own pace (18.63%), it is more comfortable (15.84%), and it cuts costs (14.24%).[14] This also appears evidently in the present study that student understands the strength and weakness of the online mode of teaching, student autonomy is provided by the online mode, but the personal relevance of the study needs more emphasis through modified coursework.

It is a big responsibility of faculty to form a conducive learning environment, timely and focused feedback from students helps in building up an environment for constructive learning, early identification of learning difficulties and provision of timely support to help students in learning. In the present study, we found that 18.83 was the mean of first-year students to the domain students' interaction as compared to 16.47 for final-year students, which was low. In medical education, we all appreciate the need for collaborative learning. The strikingly low score among final-year students surveys the need for the evaluation and identification of the reason for the student's low score.

In a study by Zhou et al., two groups of interns were formed for comparison during an epidemic and nonepidemic period. In this study, it was that the satisfaction level of group 2 (epidemic period) for teaching was better than that of group 1 during the nonepidemic period. However, in our study, we found the result to be dissimilar from the above mentioned study, we found that that 19.8% in the first year and 17.9% expressed that the distance learning environment was satisfactory, while most of the students are referring the offline teaching as better than the distance learning program.[15]

In a study by Rafi et al., 72.8% of students used mobile data, while 17.8% used broadband equipment. Most students preferred recorded classes to live classes.[16] Recorded classes allow students to revisit the topic and help in the clearance of doubts of students.

In the present study, 10.7% was the mean of “ active learning domain.” as compared to 9.12 % for final year students. 22.6% first-year students found that the topic was of personal relevance in the first year as compared to 18.45 % final year students. 47% student expect the length of classes should be between 30 and 45 min while 42% prefer for shorter than 30 min classes in a study by Rafi et al.[16]

In a study by Verma et al., 47% of students want online classes to be part of the program and 21% are not satisfied with the internal review process as it is not adequate to motivate them to summarize the whole topic. Similarly, in the present study, we observe the lowest mean score of 2.57% for the question “Distance education is exciting” which emphasizes that in medical education offline face-to-face teaching is preferred by students.[17]

The results from this study of Khalil et al. infer that students accept the synchronized online classes, in this research paper it was stated, that it reflects opportunity and Paradigm shift of traditional to online teaching.[18]

In a study by De Ponti and Marazzato,[6] 94% of students completed a questionnaire, whereas, in the present study, 81% of students completed the questionnaire. 90% favor virtual training, 93% praised online training format, while 32% found difficulty in navigating the Internet. In the present study for the question relating the education in a real-world scenario mean was 3.6 (first-year students) which was higher showing the strength of online education as compared to the means of other answers.

In a study by Gyampoh et al., the results indicated that only 33.3% of the respondents (instructors) could teach confidently online, while 66.7% needed more training to confidently deliver lessons online.[19]

In a study by Korkmaz and Toraman, 1016 teachers participated in the study. The data were gathered and analyzed using descriptive statistics using an online questionnaire created by the researchers. Most of them affirmed that they face several issues during online teaching. It was stated that there is a need to reform educational policy post-COVID era, considering the important suggestion.[20]

In a study by Wang et al., it was observed that the higher the learning stages of students, the lower student satisfaction with ongoing online education.[21] In the present study results are similar to the study stated above, Mean of many questions in final year students are lower than in the first year, Lower median was recorded in final year students in all the domains as compared to first-year students.

In a study by Baticulon et al., 3421 (93%) of the 3670 medical students possessed a smartphone and 3043 (83%) had a laptop or desktop computer. 2916 (79%) had a postpaid Internet connection to access web services, while 696 (19%) used prepaid smartphone data.[22] Availability of proper equipment is necessary for active learning; the median score for active learning domain learning was 9 for the final year and 11 for the first year; and the maximum score was 15 and the minimum score was 6.

In a study by Al-Balas et al., the questionnaire was completed by a total of 652 people, including 538 students (82.5%) engaged in distance learning in their medical schools in the wake of the COVID-19 pandemic. In medical distance learning, the average satisfaction rate was 26.8%. In the present study for the domain of distance learning satisfaction maximum score was 40 and the minimum was 8, 21 for the first year and 17 for the final year. The final-year students were less satisfied with online teaching.[23]

In a study by Choi et al., out of 32 UK medical schools, four hundred and forty students replied. Most students agreed that it was important to take steps during this pandemic to improve their curriculum. Respondents also accepted that a good learning experience will be working in hospitals during the epidemic.[24] Students understood that online teaching was an essential step to be taken by the administration during the COVID pandemic.

The North American Council for Online Learning has created a national standard for high-quality online instruction. The prepared rating scale has a range from 0 to 4. Numerous criteria are mentioned in this guideline, including educational background, necessary technological skills, and frequent feedback. Teachers are being given role models for appropriate, moral, safe, and healthy behavior when using technology.

Teachers' expertise in online learning from the viewpoint of a student, competency development, and learning process assessment via assignments and projects were also mentioned.[25]

In the current research, we used the DELES scale, which also assesses students' perceptions of active and genuine learning. The students' perceptions of the teachers' comments, their encouragement to participate in online learning, and their proper handling of their questions were recorded on this scale. Medical students in their last year had a mean instructor support level of 21.3 compared to 23.9 in their first year. Due to the clinical focus of the final-year MBBS courses, students anticipate greater technical assistance from their instructors to help them grasp the material.

Graham, Cagiltay, Byung-Ro, Craner, and Duffy (2001)[26] wrote the famous Seven Principles of Effective Teaching: A Practical Lens for Evaluating Online Courses, which has driven the development of several e-learning assessment methods. Few of the seven principles is student–faculty engagement, encouraged and directed conversations and tasks that promote student collaboration, and active participation in project-based learning, rapid feedback, usage of deadlines, and establishment of communication with students.[27]

In DELES scale through different domains, these principles were applied: instructor support (D1), student interaction and collaboration (D2), personal relevance (D3), authentic learning (D4), active learning (D5), student autonomy (D6), and student satisfaction in distance learning process (D7).

The AICTE (Open and Distance Learning Education and Online Education) Guidelines, 2021, have been issued by the All India Council for Technical Education, India, opening the door for some technical education courses to be given online. The guidelines are noteworthy because they strive to govern the provision of online and open and remote programs in technical education. They also give a more thorough structure for universities to provide online programs.[28] Online education is changing the face of India's education system. Since the implementation of the New Education Policy (NEP) in 2020.[29]

India is opening the door to a new education strategy via its NEP, but as we all saw during the COVID pandemic, a dedicated online platform for higher education is still required. Every remote area requires network connectivity, and teachers' technological skills must be updated. In the current research, students' perceptions are assessed using a distance education tool, i.e. DELES, and this study focuses on the fundamental needs of proper guidelines for medical students for better understanding of courses through an online platform as well.


The current study was restricted only to medical students from one institute. Further, the study was limited to the perception of learners about online classes conducted during COVID pandemic.

  Conclusion Top

The finding of this study indicated that the majority of students were satisfied with instructor's support and personal relevance of the online learning classes but were unsatisfied with opportunities of student interaction and group discussion which is essential in medical education. Hence, they did not perceive it as authentic learning process. As final year of medical education having clinical posting which is mentioned in the domain of “student interaction and active learning “ The process of online learning was shown to be dissatisfactory in it.

Thus, we can conclude that the online learning can be a good adjuvant for the vast theory classes, and for revision of the topics, it may not be helpful to replace practical classes and clinical postings.

It was also concluded that student autonomy is provided by the online mode and first-year students showed adaptive response toward the online learning process, but final-year students were not satisfied with distance learning environment.


The practical implication of this study states that instructor support and well-designed course content led to student satisfaction. Timely feedback improves students' performance. In a challenging period like COVID 19, Implementing Technologies for Teaching learning reveals novel avenues for online education. This new online system will be helpful for those students who do not get the opportunity of education due to a lack of resources. As it opens doors for lots of resources, it brings the responsibility of conscientious use of these resources for a practical and valuable education. Collaboration between teacher—student, student–student, and teacher–teachers plays a very important role. The development of online resource materials which include collaboration and interaction is a challenge which we all should accept for future development of the online teaching mode of medical education.


We thank our institute for providing the infrastructure and their research facilities.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3]


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