This cross-sectional study was conducted during the COVID-19 pandemic lockdown in Jordan, which lasted from March 15 to May 7, 2020. The study aimed to assess the perceptions of medical students regarding the implementation of DEL during this period.

The target sample included fourth-, fifth-, and sixth-year medical students from all 6 medical schools in the country, encompassing various training specialties. The total estimated number of eligible participants in the national sample was around 3500-4000 students. The sample size for the study was calculated using Raosoft software. The study population (n=700) was entered into the software, and the recommended sample size was 245. In this study, a total of 700 students were given the questionnaire. Out of these, 256 students completed the survey and provided their responses, equaling a response rate of 36.6%.

Content with face validity is defined as that which “simply looks relevant to the person taking the test. It evaluates the appearance of the questionnaire in terms of feasibility, readability, consistency of style and formatting, and the clarity of the language used” [13]. To gather data, we developed a comprehensive questionnaire. The questionnaire underwent a face validity assessment by 5 independent academic members from the our medical school who were not involved in the study. The questionnaire was improved based on the suggestions provided by the experts. They provided their feedback by proposing some modifications, deletions, and additions. We documented all these proposed amendments, performed them, and then adopted them to conduct the study. Additionally, feedback from 20 clinical students was incorporated into the final version. We further ensured that the questionnaire, as a tool for data collection, was delivered to the participants without errors or ambiguity. The questions included were directly collected after the responses were sent from the participants. All these approaches accommodated the validity and reliability of the instrument adopted.

The questionnaire consisted of 5 sections addressing the following different aspects of the student’s experiences with DEL:

The reliability of the questionnaire was tested using Cronbach α, and the value of the stability coefficient was calculated to be .871, which was acceptable.

The verified questionnaire was distributed via the formal social networking sites used by all medical students in the country (including Facebook, LinkedIn, and Instagram) 4 weeks after the implementation of DEL. The survey remained open for 8 weeks, and a reminder email was sent 2 weeks after the initial launch to encourage participation.

The data analysis involved analyzing the participants’ perception of the quality and value of the DEL applications using SPSS Statistics version 22 (IBM). The responses on the Likert scale were analyzed by calculating the percentages of agreement for each statement. Correlation analysis was performed to examine the relationships between the different variables. The statistical measure used was the Spearman correlation test (r_s), and significance levels were indicated with 2-tailed P values. The Spearman correlation test is not limited to continuous data; it can be used to test ordinal or categorical data. Since this study comprises a categorical data set, Spearman correlation was performed.

This study was approved by the ethical committee of the medical school of Al-Balqa Applied University (MD/56/41/1381) and was conducted according to the Declaration of Helsinki. Informed consent was signed by each participant after a clear understanding of the study objective was provided. The Institutional Review Board ensured that the study adhered to ethical guidelines and standards, protecting participants’ rights, confidentiality, and welfare.

The main findings of this study regarding the influence of DEL on senior medical students during the COVID-19 shutdown in Jordan are as follows. First, a large number of participants (n=114, 45.4%) had no prior experience with this type of learning and were compelled to pursue it due to the circumstances. Despite being relatively unfamiliar with remote learning, the low number of unfavorable responses suggested that the students were willing to try this new teaching style or at least acknowledge its necessity and usefulness. It is worth noting that Jordanians have a high level of computer literacy, with a significant portion of the population owning smartphones and using social media platforms.

The results demonstrated that there was a significant and positive correlation between the perception of quality and the learning experiences of students. The audio and video quality was moderately associated with learning experience, while the application of clinical knowledge obtained through DEL to patients was strongly correlated with learning experience. Furthermore, enjoyable and comfortable experiences of DEL were strongly associated, and students were eager to try DEL in the future.

Given the mainly unfamiliar audience, the low number of unfavorable replies suggests that students were eager to attempt the new teaching style or at the very least appreciated its necessity and use. Furthermore, Jordanians are computer savvy, with 38% of the population owning a smartphone and 84% using social media sites, such as Facebook and Twitter [14]. Still, the participants in our study almost exclusively used Microsoft Teams and Zoom despite the wide variety of options.

On the subject of usefulness, the participants were rather reluctant, with only 42% rating the usefulness of DEL as positive or rather positive, while 36% rated it as negative or rather negative. They seemed fearful of incorporating this methodology into their “normal” curriculum. This was also depicted in the negative stance of 64% of students to the possibility of substituting classic teaching with DEL. The negative and positive responses were equally divided regarding both the enjoyment of the experience and the possibility of trying it in the future (roughly 40% of each group for each question).

The transformation of education from formal person-to-person classroom interactions to web-based informal meetings has greatly impacted medical education worldwide. Students are not accustomed to this type of learning, so it is not surprising that only 30% maintained a “regular” studying schedule, while 40% admitted that their schedule was upsetting. Studying is an integral part of medical education, with top students studying 6-8 hours per day in the preclinical stage [15]. Nevertheless, it is essential to diversify the concept of learning and incorporate the ever-changing conditions, either in the form of advancement or in the form of disruption [16].

Aside from the academic value of face-to-face learning, returning to traditional, on-site teaching provides much-needed social interaction for youths. When we analyzed student-patient relations, 60% missed direct in-person interactions and 77% missed their hospital-based clinical rounds. In a similar study in Singapore, two-thirds of medical students of all stages favored returning to the classrooms rather than continuing remote learning [17]. Another study of Swiss students before and after the COVID-19 lockdown showed increased levels of stress, anxiety, loneliness, and depression, with female students experiencing the symptoms more intensely [18].

Overall, the first attempt at medical teaching through DEL has received a positive note, both on a technical level as well as on the content. Luckily, digitization in Jordan is extensive and the infrastructure is in place to ensure technical efficiency throughout the country [19]. In terms of content, the migration of the course to a digital form did not reduce its quality and educational value. However, in terms of clinical value, the results were worrisome since only one-third of the students felt they could apply their knowledge to actual patients [20].

Apart from the theoretical knowledge medical students receive, they also are taught, through the example of their mentors, how to interact with patients. Clinical rounds help them familiarize themselves with medicine-in-practice in everyday situations. Additionally, peer discussions with fellow students are an effective method of deep learning in 81% of male and 89% of female students [15]. Clinical practice is based on observation, examination, investigation, and critical assessment to identify proper differential diagnoses, diagnose, treat, and sometimes operate on patients. All these skills can only be obtained by hands-on application and live peer interaction. This is the reason why only 39% of students were comfortable with the knowledge gained from DEL. Maybe more digital interaction should be implemented as a mandatory course or training to make the students more familiar with modern technologies and prepare them for the future when digital health will become mainstream.

This study highlights the technical capability of Jordan to support digital medical training and recognizes the value and significant contribution of DEL in continuing medical education during the COVID-19 pandemic. However, the findings indicate that the students in this study showed reluctance and fear toward digitization, suggesting the need for further efforts to familiarize them with this educational approach. While DEL cannot fully replace traditional clinical teaching, it should be integrated as an integral part of medical education, serving as a complementary tool in the clinical setting. This study conducted a comprehensive data analysis, exploring multiple dimensions of DEL, such as prior experience, user-friendliness, and the potential for substitution of traditional clinical teaching. This thorough analysis provides a nuanced understanding of students’ attitudes and perceptions regarding DEL. Furthermore, the study’s focus on a timely and relevant topic, namely, the impact of DEL during the COVID-19 pandemic, highlights its practical implications for medical education. The findings shed light on the role of DEL as a necessary and valuable tool in modern medical education, while also emphasizing the need to address students’ concerns and integrate DEL as an auxiliary approach in the clinical setting. By offering valuable insights and recommendations, this study has the potential to inform and guide educational strategies in similar contexts.

This study has several limitations that should be acknowledged. First, the research was conducted during the COVID-19 pandemic lockdown, which created an unprecedented and unique educational context. The findings may be influenced by the specific circumstances of the pandemic and the abrupt shift to DEL, limiting their generalizability to other periods or nonpandemic situations. Moreover, the study relied on a self-report questionnaire, introducing the possibility of response bias. Participants may have provided answers that they believed were expected or socially desirable, potentially affecting the accuracy and reliability of the data. Third, the study focused on senior medical students in Jordan, which may limit the generalizability of the findings to other populations or educational settings. The cultural, institutional, and educational context of Jordan may have specific influences on students’ perceptions and experiences with DEL that differ from those in other regions. Additionally, the study did not assess the long-term effects or outcomes of DEL on students’ learning and clinical skills, which could provide further insights into the effectiveness and limitations of this educational approach.

DEL is rapidly infiltrating medical schools, and this fact should be considered while designing the curriculum for future physicians. Because of their lack of experience, the students in this study were hesitant and worried about shifting to digital medical education. We are confident that calculated gradual, modest encounters will be of great benefit to clinical teaching. Future longitudinal studies are needed to evaluate all aspects of digital learning in clinical teaching for medical students. Moreover, future research and initiatives should aim to address students’ concerns and optimize the implementation of DEL to enhance the overall medical education experience.