Highlights
- •We explored the training efficacy at IMHTCT during the COVID-19 pandemic.
- •We recruited healthcare workers in Southeast Asia.
- •Training efficacy was estimated using the ITLEQ, and it was shown to have good reliability and validity.
- •Online training was associated with better training efficacy among social workers and occupational therapists.
- •The potential efficacy of online training was found in nurses.
Abstract
Study objectives
The coronavirus disease 2019 (COVID-19) pandemic has resulted in major disruption to regular learning and training for medical staff. The aim of this study was to compare the learning efficacy between on-site training before the COVID-19 pandemic and online training during the pandemic for nurses, psychologists, social workers, and occupational therapists from Southeast Asia.
Method
The current study derived data from the International Mental Health Training Center Taiwan (IMHTCT) from 2018 to 2020. IMHTCT Trainees Learning Effect Questionnaire (ITLEQ) scores of the medical staff and demographic variables were collected. Reliability and validity of the ITLEQ were estimated. The independent t-test was used to compare differences in ITLEQ scores between the pre-training and post-training stages among the trainees. In addition, generalized estimating equations were used to estimate the predictive effect of online training on changes in ITLEQ scores over time.
Findings
A total of 190 trainees were enrolled, including 92 social workers, 16 occupation therapists, 24 psychologists, and 58 nurses. The reliability and validity were satisfactory. The efficacy of the training programs at IMHTCT was significant for all of the healthcare workers. Furthermore, better training efficacy was found in the social workers and occupational therapists who received online training compared to those who received on-site training. The potential efficacy of online training was found in the nurses.
Conclusion
Our results demonstrate the importance of online training for mental healthcare workers during the COVID-19 pandemic. Online training may be implemented into regular training courses in the future.
Keywords
Introduction
Collaboration of training on mental health between Southeast Asia and Taiwan
Mental health systems differ across Southeast Asian countries. For instance, some countries, such as Vietnam, has preliminary mental health policies and programs without legislation (
Samaniego, 2017
), whereas Philippines, Singapore, Thailand, and Indonesia, have implemented mental health policies and related laws (Ito et al., 2012
; “REPUBLIC ACT No. 11036, 2018
). However, some of the mental health resources are generally insufficient, such as existing infrastructure, human resources, and financial resources for elderly populations (Pandey et al., 2022
). Taiwan is located close to Southeast Asia, and multidimensional relationships exist between them. Southeast Asia is close to Taiwan both geographically and racially, and they share common psychological, social, and cultural factors, as well as traditions and family cohesion (Kai-Da et al., 2015
). Therefore, the intertwined relationships between Southeast Asia and Taiwan can be an opportunity to bridge academic and practical collaboration on mental health. Since 2009, several experts on mental health and official mental health agencies in Taiwan have worked on developing the “Building the Collaborative Research Platform and Professional Training Workshop for Community Mental Health in Developing Countries” project to foster academic and practical collaboration with Southeast Asia (Hsu et al., 2017
). Based on this project, the International Mental Health Training Center Taiwan (IMHTCT) was created to develop specific training programs for mental healthcare workers in Southeast Asia. As such, they are invited to IMHTCT to receive specific training programs.- Hsu S.-T.
- Yang D.-W.
- Hsieh K.-Y.
- Lu Y.-S.
- Tjoei D.S.
- Thanh D.D.
- Chen C.-C.
Integrating into the global community: The international collaboration with Southeast Asia of Kai-Syuan psychiatric hospital.
[和國際社接軌:凱旋醫院的東南亞合作經驗]. Taiwanese Journal of Psychiatry (Taipei). 2017; 31: 300-308https://doi.org/10.29478/TJP
Impact of COVID-19 on mental health training
The coronavirus disease 2019 (COVID-19) pandemic has had a great impact on society globally. Due to the rigorous policies of infection control and broader customs control in Taiwan, on-site training in Taiwan was temporarily halted, and online training programs were developed as an alternative. Regular medical training has also been severely affected by the COVID-19 pandemic. A previous study found that Objective Structured Clinical Examination (OSCE) quiz scores were higher in students who received in-person training than in those who received virtual training (
Zhang and He, 2022
). Another study also reported the burden of e-learning for medical students (- Zhang N.
- He X.
A comparison of virtual and in-person instruction in a physical examination course during the COVID-19 pandemic.
Journal of Chiropractic Education. 2022; https://doi.org/10.7899/JCE-21-12
Alsoufi et al., 2020
). However, other studies have demonstrated that online training was beneficial with regards to saving time and higher flexibility for medical students (- Alsoufi A.
- Alsuyihili A.
- Msherghi A.
- Elhadi A.
- Atiyah H.
- Ashini A.
- Elhadi M.
Impact of the COVID-19 pandemic on medical education: Medical students' knowledge, attitudes, and practices regarding electronic learning.
PLoS One. 2020; 15e0242905https://doi.org/10.1371/journal.pone.0242905
Dost et al., 2020
; - Dost S.
- Hossain A.
- Shehab M.
- Abdelwahed A.
- Al-Nusair L.
Perceptions of medical students towards online teaching during the COVID-19 pandemic: A national cross-sectional survey of 2721 UK medical students.
BMJ Open. 2020; 10e042378https://doi.org/10.1136/bmjopen-2020-042378
Khalil et al., 2020
). Although a shift to e-learning may be feasible during the pandemic, learning efficacy will be influenced by technological capabilities, equipment, and perceptions of both teachers and students (Camargo et al., 2020
). In summary, both opportunities and challenges exist with online learning during the COVID-19 pandemic.- Camargo C.P.
- Tempski P.Z.
- Busnardo F.F.
- Martins M.A.
- Gemperli R.
Online learning and COVID-19: A meta-synthesis analysis.
Clinics (São Paulo, Brazil). 2020; 75e2286https://doi.org/10.6061/clinics/2020/e2286
Aim of the current study
As the COVID-19 pandemic progresses, timely adjustment of training programs at IMHTCT are warranted. Even though restrictions are gradually being lifted due to vaccinations, online training should still be considered as an alternative due to uncertainty with the pandemic. However, the efficacy of online training remains inconclusive (
Alsoufi et al., 2020
; - Alsoufi A.
- Alsuyihili A.
- Msherghi A.
- Elhadi A.
- Atiyah H.
- Ashini A.
- Elhadi M.
Impact of the COVID-19 pandemic on medical education: Medical students' knowledge, attitudes, and practices regarding electronic learning.
PLoS One. 2020; 15e0242905https://doi.org/10.1371/journal.pone.0242905
Camargo et al., 2020
; - Camargo C.P.
- Tempski P.Z.
- Busnardo F.F.
- Martins M.A.
- Gemperli R.
Online learning and COVID-19: A meta-synthesis analysis.
Clinics (São Paulo, Brazil). 2020; 75e2286https://doi.org/10.6061/clinics/2020/e2286
Dost et al., 2020
). To address this gap in the knowledge, we conducted this follow-up study to compare differences in learning efficacy between on-site training before the COVID-19 pandemic and online training during the pandemic for nurses, psychologists, social workers, and occupational therapists from Southeast Asia.- Dost S.
- Hossain A.
- Shehab M.
- Abdelwahed A.
- Al-Nusair L.
Perceptions of medical students towards online teaching during the COVID-19 pandemic: A national cross-sectional survey of 2721 UK medical students.
BMJ Open. 2020; 10e042378https://doi.org/10.1136/bmjopen-2020-042378
Methods
The IMHTCT
The IMHTCT is an international training center for mental health under the authority of the Ministry of Health and Welfare, Taiwan. The center is composed of five leading psychiatric hospitals in Taiwan, including Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (KSPH), Tsaotun Psychiatric Center, Taoyuan Psychiatric Center, Jianan Psychiatric Center, and Taipei Veterans General Hospital Yuli Branch. The purpose of the IMHTCT is to integrate Taiwan's mental health network and collaborate with countries in Southeast Asia through international conferences, on-site visits, and training programs.
The IMHTCT recruits trainee mental healthcare workers, including psychiatrists, nurses, clinical psychologists, social workers, and occupational therapists from Southeast Asian countries. The training programs provided by IMHTCT include clinical knowledge, practical skills, community-based practice, geriatric mental health, hospital management, and related knowledge. All of the training programs were developed by experts of mental health in Taiwan and reviewed by international collaborators to ensure the applicability and availability for trainees from different countries. Before 2020, the IMHTCT provided on-site training, and international trainees were required to travel to the training hospitals in Taiwan. The on-site training included lectures and clinically practicing programs. However, online training with only lectures has been conducted since the outbreak of COVID-19 pandemic. The topics of lectures in the online programs are the same as those in the on-site training programs. Teachers of the online training programs use the Multimedia on Demand (MOD) system in KSPH to deliver the training courses in other countries. Trainees can watch recorded lectures using the MOD system, and they can ask lecturers questions through the interactive MOD systems or by e-mail after class if they have any questions. These training programs are specialized according to the occupations of the trainees. For instance, nursing care training programs cover patient safety, infection control, nursing assessment for mental illness, and violence prevention. Details of the training courses for nurses, psychologists, social workers, and occupational therapists are listed in Supplementary Table S1.
Participants and ethics
This retrospective study used data from the electronic database of IMHTCT. Data of on-site training from 2018 to 2019 and data of online training in 2020 were included. Trainees voluntarily filled in questionnaires before and after the training programs to estimate the learning efficacy and satisfaction. The inclusion criteria were: 1) trainee nurses, psychologists, social workers and occupational therapists who attended IMHTCT training programs; and 2) those who completed the training programs. Data of trainees with missing values in the questionnaires were excluded. We also excluded the data of psychiatrists because no psychiatrists registered for online training in 2020. This study was approved by the Institutional Review Board of KSPH (KSPH-2022-07) and carried out in accordance with the current revision of the Declaration of Helsinki and Taiwan's national legal requirements.
Measures
The IMHTCT Trainees Learning Effect Questionnaire (ITLEQ)
The ITLEQ is a self-reported questionnaire which was developed to estimate the level of knowledge or efficacy of training courses. To enhance the face validity, experts and clinical workers from Taiwan and Southeast Asia were invited to expert meetings to develop specific questionnaires. Four versions of the ITLEQ were developed according to the specialty of the healthcare workers: ITLEQ for nurses (ITLEQ-Ns), psychologists (ITLEQ-Psycho), social workers (ITLEQ-SW), and occupational therapists (ITLEQ-OT). The numbers of questions on the ITLEQ-Ns, ITLEQ-Psycho, ITLEQ-SW, and ITLEQ-OT were 22, 5, 10, and 8, respectively. Each question was rated on a seven-point Likert scale, with scores ranging from 1 (strongly disagree) to 7 (strongly agree). A higher total score indicated a higher level of knowledge regarding the training course. According to the protocol of IMHTCT, the ITLEQ was assessed after the lectures and after completions of clinically practicing programs. In this study, we only included scores of ITLEQ after lectures for onsite training because that there were no clinically practicing programs during the period of online training. In addition, the ITLEQ was assessed once after lectures of online training. Details of the questionnaire are listed in Supplementary Table S2.
Demographic characteristics
Demographic data including age, sex (male or female), duration of employment, and online training (yes or no) were recorded. Duration of employment indicated the duration of specialty for trainees, including nurses, psychologists, social workers, and occupational therapists. Online training manifested if trainees received online training in 2020 or on-site training in 2018 or 2019.
Statistical analysis
Descriptive analysis was performed on the demographic variables. Pearson's χ2 test was used to compare categorical variables within the four groups of trainees, and post-hoc comparisons were made with the Bonferroni test. A p-value of 0.00125 was used to indicate significance in the Bonferroni test. In addition, one-way between-group analysis of variance (ANOVA) was conducted to explore differences in continuous variables between groups. The F-statistic was further applied, and post-hoc comparisons were made using Fisher's least significant difference test if the F-statistic reached statistical significance. A p-value of 0.01 was used to indicate significance in the post hoc comparisons.
To test the reliability of the ITLEQ, internal consistency was estimated by Cronbach's α, with a value > 0.8 indicating good reliability (
Taber, 2018
). Exploratory factor analysis (EFA) was used to examine construct validity. First, the Kaiser–Mayer–Olkin (KMO) measure of sampling adequacy and Bartlett's test were used to test the adequacy of the EFA. The data were acceptable for factor analysis if the KMO value was >0.60 and significance (p < 0.05) was identified in Bartlett's test (Tabachnick and Fidell, 2007
). According to the assumption that the factors were correlated, principal axis factor analysis was conducted with varimax rotation, and total variance explained (%) was also estimated. Variance indicates how well a relevant notion can be measured (), and the acceptable threshold of total variance explained is at least 60 % (Hair, 2010
).In order to estimate the efficacy of the training course, the independent t-test was used to compare differences in ITLEQ scores (ITLEQ-Ns, ITLEQ-Psycho, ITLEQ-SW, and ITLEQ-OT) between the pre-training and post-training stage among the trainees. The alpha level of the t-test was set at 0.05. Moreover, generalized estimating equations with a first-order autoregressive working correlation structure (
Zeger and Liang, 1986
) were used to analyze the predictive effect of online training on changes in ITLEQ scores over time by controlling for the effects of demographic factors, including sex, age, and duration of employment. All data were processed using SPSS version 23.0 for Windows (SPSS Inc., Chicago, IL, USA).Results
Summary of demographic characteristics
A total of 190 trainees were enrolled, including 92 social workers, 16 occupation therapists, 24 psychologists, and 58 nurses. A significantly higher proportion of the social workers were male (44.6 %) compared to the psychologists (8.3 %). In addition, a significantly higher proportion of the social workers received online training (59.8 %) compared to the nurses (15.5 %). However, the results of ANOVA demonstrated no significant differences in age and duration of employment across the four groups. Details of the comparisons are listed in Table 1.
Table 1Characteristics and comparisons of demographic variables (n = 190).
| Staff | Social worker | Occupation therapist | Psychologist | Nurse | Statistics |
|---|---|---|---|---|---|
| Categorical | n (%) | n (%) | n (%) | n (%) | p |
| Total | 92 (100) | 16 (100) | 24 (100) | 58 (100) | – |
| Sex | 0.001 | ||||
| Male | 41 (44.6) | 8 (50) | 2 (8.3) | 13 (22.4) | Male: SW > Psycho |
| Female | 51 (55.4) | 8 (50) | 22 (91.7) | 45 (77.6) | Others: N.S. |
| Online training | <0.001 | ||||
| No | 37 (40.2) | 12 (75) | 14 (58.3) | 49 (84.5) | SW > Nurse Others: N.S. c |
| Yes | 55 (59.8) | 4 (25) | 10 (41.7) | 9 (15.5) | |
| Staff | Social worker | Occupation therapist | Psychologist | Nurse | Statistics |
| Continuous | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | ANOVA |
| Age | 36.09 (9.70) | 37.06 (7.82) | 36.63 (7.80) | 37.64 (9.10) | N.S. |
| Duration of job | 9.12 (8.08) | 11.69 (8.27) | 8.42 (6.57) | 11.64 (7.98) | N.S. |
SD: standard deviation; ANOVA: analysis of variance; N.S.: non-statistical significance; bold values indicate statistical significance.
a : Pearson's χ2 test.
b Receive online training due to COVID-19 pandemic.
c Post hoc analysis with Bonferroni test.
Reliability and validity of the ITLEQ
The Cronbach's α values of the ITLEQ-Ns, ITLEQ-Psycho, ITLEQ-SW, and ITLEQ-OT were 0.93, 0.95, 0.97, and 0.94, respectively. All of them reached excellent reliability (
Taber, 2018
). After EFA, the KMO coefficients of sampling adequacy for the ITLEQ-Ns, ITLEQ-Psycho, ITLEQ-SW, and ITLEQ-OT were 0.87, 0.86, 0.92, and 0.92, respectively. All of the KMO coefficients were within an acceptable range. In addition, Bartlett's test of sphericity, which assesses whether a matrix differs from the identity matrix, yielded significant results (p < 0.001) for the four ITLEQs. This supported the presence of factors within the data. Furthermore, the ITLEQ-Ns, ITLEQ-Psycho, ITLEQ-SW, and ITLEQ-OT explained 74.16 %, 85.97 %, 85.36 %, and 72.3 % of the total variance, which were within an acceptable range. In brief, the results of EFA demonstrated that the factors extracted from the items of the ITLEQ could appropriately interpret all of the items. Details are listed in Table 2.Table 2Reliability and validity (exploratory factor analysis) of IMHTCT Trainees Learning Effect Questionnaires (ITLEQ).
| ITLEQ for specialist | Cronbach's α | KMO values | Bartlett's test (p) | Total variance explained (%) |
|---|---|---|---|---|
| ITLEQ-SW | 0.966 | 0.917 | <0.001 | 85.358 |
| ITLEQ-OT | 0.943 | 0.919 | <0.001 | 72.303 |
| ITLEQ-Psycho | 0.945 | 0.856 | <0.001 | 85.966 |
| ITLEQ-Ns | 0.929 | 0.872 | <0.001 | 74.159 |
IMHTCT: International Mental Health Training Center Taiwan; KMO: Kaiser-Meyer-Olkin test; OT: occupation therapist; Psycho: psychologist; SW: social worker Ns: nurse.
Differences in the scores and predictors of the ITLEQ
Table 3 demonstrates the differences in the scores of the ITLEQ-Ns, ITLEQ-Psycho, ITLEQ-SW, and ITLEQ-OT. All of the trainees in all four groups had significantly increased ITLEQ scores after completing the training courses. We used generalized estimating equations to predict the effect of online training on changes in ITLEQ scores over time. After controlling for the effects of sex, age, and duration of employment, online training was still statistically significant in ITLEQ-SW (estimate: 4.73, p < 0.001) and ITLEQ-OT (estimate: 4.99, p = 0.036), meaning that the social workers and occupational therapists who received online training had higher increases in ITLEQ-SW and ITLEQ-OT scores than those who received on-site training (Table 4). In addition, the nurses who received online training also had an insignificant trend of a greater increase in ITLEQ-Ns score than those who received on-site training (estimate: 3.21, p = 0.108).
Table 3Difference of scores with IMHTCT Trainees Learning Effect Questionnaires (ITLEQ) between pre- and post-test for medical staff.
| ITLEQ for specialist | Pre-test | Post-test | Statistics | |
|---|---|---|---|---|
| Mean (SD) | Mean (SD) | t | p | |
| ITLEQ-SW | 25.68 (9.47) | 35.78 (5.21) | −11.14 | <0.001 |
| ITLEQ-OT | 31.06 (10.13) | 49.19 (6.02) | −6.99 | <0.001 |
| ITLEQ-Psycho | 16.13 (7.34) | 24.08 (3.80) | −6.05 | <0.001 |
| ITLEQ-Ns | 24.5 (9.16) | 35.84 (4.89) | −9.84 | <0.001 |
IMHTCT: International Mental Health Training Center Taiwan; SD: Standard deviation; OT: occupation therapist; Psycho: psychologist; SW: social worker; Ns: nurse; bold values indicate statistical significance.
Table 4Predictive effect of online training on the change of ITLEQ over time estimated with generalized estimating equations.
| Estimate | ES | SE | 95 % of CI | p | |
|---|---|---|---|---|---|
| Predictors (ITLEQ-SW) | |||||
| Online training | |||||
| No | Ref. | – | – | – | – |
| Yes | 4.73 | 112.9 | 1.32 | 8.57, 1489.2 | <0.001 |
| Predictors (ITLEQ-OT) | |||||
| Online training | |||||
| No | Ref. | – | – | – | – |
| Yes | 4.99 | 146.2 | 2.37 | 1.39, 1535.1 | 0.036 |
| Predictors (ITLEQ-Psycho) | |||||
| Online training | |||||
| No | Ref. | – | – | – | – |
| Yes | 0.19 | 1.21 | 2.27 | 0.01, 102.9 | 0.933 |
| Predictors (ITLEQ-Ns) | |||||
| Online training | |||||
| No | Ref. | – | – | – | – |
| Yes | 3.21 | 24.69 | 1.99 | 0.50, 1226.3 | 0.108 |
Ref.: reference; ES: effective size = Exp (B); SE: standard error; OT: occupation therapist; Psycho: psychologist; SW: social worker; Ns: nurse; bold values indicate statistical significance.
a Adjusted with sex, age, and duration of job.
b Receive online training due to COVID-19 pandemic.
Discussion
Main findings of the current study
In this study, we verified the reliability and validity of the ITLEQ, which satisfied the required thresholds of multiple indices. In addition, we found significant increases in the scores of the four kinds of ITLEQ, indicating the efficacy of the training programs at the IMHTCT for nurses, psychologists, social workers, and occupational therapists. In addition, the trainees who received online training during the COVID-19 pandemic had higher ITLEQ-SW and ITLEQ-OT scores than those who received on-site training, showing the efficacy of online training for social workers and occupational therapists. Moreover, the potential efficacy of online training was also found in nurses.
Efficacy of online training programs at the IMHTCT
We identified significantly better learning efficacy with online training than on-site training among social workers and occupational therapists. Online training was also found to be potentially better than on-site training for nurses. Our findings support the benefits of online training during the COVID-19 pandemic, which is consistent with some previous studies. A cross-sectional study reported that students and lecturers had a predominantly positive perspective on the implementation of online learning, and that this may suggest that online learning can be used even beyond the COVID-19 pandemic (
Schlenz et al., 2020
). Another study also demonstrated that online learning may represent an optimal solution to maintain learning processes in unexpected and emergency situations such as the COVID-19 pandemic(Al-Balas et al., 2020
). Most previous studies have focused on online learning for students, whereas we further extended the applicability of online training to licensed medical staff.However, several problems with online training should be addressed. First, the impact on visual function with online training remains a challenge (
Fan et al., 2021
). Adequate desktop illumination, limited class time, sufficient rest time between classes, daily outdoor activities, and sufficient sleep may be beneficial for students and trainees receiving online training (- Fan Q.
- Wang H.
- Kong W.
- Zhang W.
- Li Z.
- Wang Y.
Online learning-related visual function impairment during and after the COVID-19 pandemic.
Frontiers in Public Health. 2021; 9645971https://doi.org/10.3389/fpubh.2021.645971
Fan et al., 2021
). Second, unfamiliarity with online training may hinder delivery. One study reported that satisfaction with online learning was significantly higher in students with previous experience in distance learning than in those without experience(- Fan Q.
- Wang H.
- Kong W.
- Zhang W.
- Li Z.
- Wang Y.
Online learning-related visual function impairment during and after the COVID-19 pandemic.
Frontiers in Public Health. 2021; 9645971https://doi.org/10.3389/fpubh.2021.645971
Al-Balas et al., 2020
). Therefore, it may take time to effectively deliver online training and enhance satisfaction after refining the delivery methods. Third, delivery knowledge of experimental or clinical practice may be limited during online training. It has also been argued that over-reliance on online training limits opportunities for experiential learning or “hands-on” practice, which is considered to be essential for acquiring the behavioral repertoire (Warren et al., 2020
). The above literature may echo the result of our study, where the efficacy of online training for nurses is only a trend. It is crucial for nursing education with floor nursing skills, “hands-on” skills, and life-saving skills, which are difficult to be delivered in the online training. Finally, technological requirements may also limit the application of online learning. E-learning satisfaction levels have been reported to be better among students in developed countries compared to those in developing countries (Abbasi et al., 2020
). However, this may vary according to the geographical location. We found high learning efficacy with online training, and most of the trainees came from developing countries. As all of the trainees were medical staff they may have had a relatively high socioeconomic status, and so they were able to afford internet and communication devices. Further research is warranted to clarify internet usage in Southeast Asian countries.The IMHTCT provides recorded lectures for trainees through the MOD system. Previous studies have addressed the choices of recorded lectures or live interaction in the application of online learning due to the COVID-19 pandemic (
Camargo et al., 2020
; - Camargo C.P.
- Tempski P.Z.
- Busnardo F.F.
- Martins M.A.
- Gemperli R.
Online learning and COVID-19: A meta-synthesis analysis.
Clinics (São Paulo, Brazil). 2020; 75e2286https://doi.org/10.6061/clinics/2020/e2286
Evans et al., 2020
; Gewin, 2020
; Newman and Lattouf, 2020
). Online training with live interaction may be more dynamic than recorded lectures; however, internet connectivity problems may hinder the learning efficacy (Camargo et al., 2020
; - Camargo C.P.
- Tempski P.Z.
- Busnardo F.F.
- Martins M.A.
- Gemperli R.
Online learning and COVID-19: A meta-synthesis analysis.
Clinics (São Paulo, Brazil). 2020; 75e2286https://doi.org/10.6061/clinics/2020/e2286
Gewin, 2020
). Recorded content allows for lectures to be paused and daily activities to be adapted, making flexible attendance possible (Camargo et al., 2020
). A previous study also reported that an advantage of recorded lectures was the freedom to choose the appropriate time to study (- Camargo C.P.
- Tempski P.Z.
- Busnardo F.F.
- Martins M.A.
- Gemperli R.
Online learning and COVID-19: A meta-synthesis analysis.
Clinics (São Paulo, Brazil). 2020; 75e2286https://doi.org/10.6061/clinics/2020/e2286
Chinelatto et al., 2020
). As a result, recorded lectures may also be applicable in online training.- Chinelatto L.A.
- Costa T.R.D.
- Medeiros V.M.B.
- Boog G.H.P.
- Hojaij F.C.
- Tempski P.Z.
- Martins M.A.
What you gain and what you lose in COVID-19: Perception of medical students on their education.
Clinics (São Paulo, Brazil). 2020; 75e2133https://doi.org/10.6061/clinics/2020/e2133
Limitations
Several limitations in the current study should be addressed. First, the small number of psychologists and occupational therapists may limit the interpretation and generalizability of the results. Second, the trainee assessments were self-reported questionnaires. Therefore, it may be difficult to estimate the learning efficacy in clinical practice after class, such as clinically practicing programs. In addition, some of the assessments, such as OSCE, can only be held in on-site training but not online training. Due to the limitation of resources, the OSCE was not applied in the onsite training of IMHTCT.
Conclusions
In this study, we showed the reliability and validity of the ITLEQ, and also the significant efficacy of training programs at the IMHTCT for nurses, psychologists, social workers, and occupational therapists. Moreover, the trainee social workers, occupational therapists, and nurses who received online training during the COVID-19 pandemic had better learning efficacy than those who received on-site training. Our results demonstrate the importance of online training for mental healthcare workers during the COVID-19 pandemic. As technology and internet-connected devices become ever more common, online training may be implemented into regular training courses for medical staff after the COVID-19 pandemic. Further studies with a longer follow-up period and alternative assessments of clinical practice for trainees are suggested to better understand the learning efficacy of online training.
Ethics approval and consent to participate
This study protocol was reviewed and accepted by the Institutional Review Board of Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (approval number: KSPH-2022-07). Requirement for patient consent was waived because this study's data were retrospectively derived from an anonymous database in the International Mental Health Training Center Taiwan.
Funding
This study was supported by grants from the Taiwan Ministry of Health and Welfare (M08B8069; M07M07B4183; M09B3051; M1002094; M1102073).
CRediT authorship contribution statement
Cheng-Chung Chen: Conceptualization, Methodology, Formal analysis, Project administration, Funding acquisition, Investigation, Writing – original draft. Shu-Hui Wang: Conceptualization, Methodology, Investigation, Data curation, Project administration. Li-Shiu Chou: Data curation, Conceptualization. Lih-Jong Shen: Methodology, Project administration. Dian-Jeng Li: Conceptualization, Methodology, Project administration, Writing – review & editing.
Data availability statement
Data are available at the corresponding author (Dian-Jeng Li, M.D.). Participants did not approve a public data deposition.
Declaration of competing interest
The authors declare that they do not have any conflict of interest with respect to this research study and paper.
Acknowledgements
We thank our colleagues from the International Mental Health Training Center Taiwan and Kaohsiung Municipal Kai-Syuan Psychiatric Hospital for their assistance.
Appendix A. Supplementary data
Supplementary tables
References
- E-learning perception and satisfaction among health sciences students amid the COVID-19 pandemic.Work. 2020; 67: 549-556https://doi.org/10.3233/WOR-203308
- Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: Current situation, challenges, and perspectives.BMC Medical Education. 2020; 20: 341https://doi.org/10.1186/s12909-020-02257-4
- Impact of the COVID-19 pandemic on medical education: Medical students' knowledge, attitudes, and practices regarding electronic learning.PLoS One. 2020; 15e0242905https://doi.org/10.1371/journal.pone.0242905
- Online learning and COVID-19: A meta-synthesis analysis.Clinics (São Paulo, Brazil). 2020; 75e2286https://doi.org/10.6061/clinics/2020/e2286
- What you gain and what you lose in COVID-19: Perception of medical students on their education.Clinics (São Paulo, Brazil). 2020; 75e2133https://doi.org/10.6061/clinics/2020/e2133
- Perceptions of medical students towards online teaching during the COVID-19 pandemic: A national cross-sectional survey of 2721 UK medical students.BMJ Open. 2020; 10e042378https://doi.org/10.1136/bmjopen-2020-042378
- Going virtual to support anatomy education: A STOPGAP in the midst of the Covid-19 pandemic.Anatomical Sciences Education. 2020; 13: 279-283https://doi.org/10.1002/ase.1963
- Online learning-related visual function impairment during and after the COVID-19 pandemic.Frontiers in Public Health. 2021; 9645971https://doi.org/10.3389/fpubh.2021.645971
- Five tips for moving teaching online as COVID-19 takes hold.Nature. 2020; 580: 295-296https://doi.org/10.1038/d41586-020-00896-7
- Multivariate data analysis.7th ed. Prentice Hall, Upper Saddle River, NJ2010
- Handbook of data analysis.Sage, Thousand Oaks, CA, USA2004
- Integrating into the global community: The international collaboration with Southeast Asia of Kai-Syuan psychiatric hospital.[和國際社接軌:凱旋醫院的東南亞合作經驗]. Taiwanese Journal of Psychiatry (Taipei). 2017; 31: 300-308https://doi.org/10.29478/TJP
- Lessons learned in developing community mental health care in east and South East Asia.World Psychiatry. 2012; 11: 186-190https://doi.org/10.1002/j.2051-5545.2012.tb00129.x
- The care of the mentally ill in Taiwan.in: Routledge handbook of psychiatry in. Routledge, Asia2015
- The sudden transition to synchronized online learning during the COVID-19 pandemic in Saudi Arabia: A qualitative study exploring medical students' perspectives.BMC Medical Education. 2020; 20: 285https://doi.org/10.1186/s12909-020-02208-z
- Coalition for medical education-a call to action: A proposition to adapt clinical medical education to meet the needs of students and other healthcare learners during COVID-19.Journal of Cardiac Surgery. 2020; 35: 1174-1175https://doi.org/10.1111/jocs.14590
- Mental health promotion for elderly populations in World Health Organization South-East Asia region: Needs and resource gaps.World J Psychiatry. 2022; 12: 117-127https://doi.org/10.5498/wjp.v12.i1.117
- (Retrieved from)
- The Evolution of psychiatry and mental health in the Philippines.Taiwanese Journal of Psychiatry (Taipei). 2017; 31 (+ ii): 101-114
- Students' and lecturers' perspective on the implementation of online learning in dental education due to SARS-CoV-2 (COVID-19): A cross-sectional study.BMC Medical Education. 2020; 20: 354https://doi.org/10.1186/s12909-020-02266-3
- Using Multivariate Statistics.5th edition ed. Allyn and Bacon, New York, NY, USA2007
- The use of Cronbach’s alpha when developing and reporting research instruments in science education.Research in Science Education. 2018; 48: 1273-1296https://doi.org/10.1007/s11165-016-9602-2
- Challenges and solutions when developing online interactive psychiatric education.Australasian Psychiatry. 2020; 28: 359-362https://doi.org/10.1177/1039856220901477
- Longitudinal data analysis for discrete and continuous outcomes.Biometrics. 1986; 42 (Retrieved from): 121-130
- A comparison of virtual and in-person instruction in a physical examination course during the COVID-19 pandemic.Journal of Chiropractic Education. 2022; https://doi.org/10.7899/JCE-21-12
Article info
Publication history
Published online: December 19, 2022
Accepted:
December 10,
2022
Received in revised form:
November 7,
2022
Received:
May 11,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
