Advances in Human Biology

: 2022  |  Volume : 12  |  Issue : 2  |  Page : 87--92

The global impact of the COVID-19 pandemic on the education of healthcare professionals, especially in low- and middle-income countries

Kona Chowdhury1, Mainul Haque2, Ayukafangha Etando3, Santosh Kumar4, Halyna Lugova5, Moyad Shahwan6, Ranko Škrbic7, Ammar Abdulrahman Jairoun8, Brian Godman9,  
1 Department of Paediatrics, Gonoshasthaya Samaj Vittik Medical College and Hospital, Dhaka, Bangladesh
2 Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
3 Department of Medical Laboratory Sciences, Faculty of Health Sciences, Eswatini Medical Christian University, Mbabane, Eswatini
4 Department of Periodontology and Implantology, Karnavati University, Gandhinagar, Gujarat, India
5 Humanitarian Assistance in Disaster Relief Centre, Community Medicine Unit, Faculty of Medicine and Defence Health Research Fellow, National Defence University of Malaysia, Kuala Lumpur, Malaysia
6 College of Pharmacy and Health Science, Ajman University; Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
7 Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
8 Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates; Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
9 College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates; Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa

Correspondence Address:
Brian Godman
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE

Mainul Haque
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai, Besi 57000, Kuala Lumpur

How to cite this article:
Chowdhury K, Haque M, Etando A, Kumar S, Lugova H, Shahwan M, Škrbic R, Jairoun AA, Godman B. The global impact of the COVID-19 pandemic on the education of healthcare professionals, especially in low- and middle-income countries.Adv Hum Biol 2022;12:87-92

How to cite this URL:
Chowdhury K, Haque M, Etando A, Kumar S, Lugova H, Shahwan M, Škrbic R, Jairoun AA, Godman B. The global impact of the COVID-19 pandemic on the education of healthcare professionals, especially in low- and middle-income countries. Adv Hum Biol [serial online] 2022 [cited 2022 Aug 19 ];12:87-92
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Full Text


The COVID-19 disaster has appreciably increased morbidity and mortality, as well as the delivery of health care, across countries exacerbated by the contagious nature of the virus.[1],[2],[3],[4] Numerous public health measures were instigated across countries at the start of the pandemic to try and limit its spread without effective medicines and vaccines.[5],[6] Introduced measures included lockdown activities, social distancing instructions, quarantining measures, wearing of personal protective equipment (PPE), handwashing and sanitisers, as well as the closure of borders.[5],[6],[7],[8] Instigated measures also included the closure of universities, appreciably affecting the education of health-care professionals (HCPs), including physicians and pharmacists, across countries.[9],[10],[11] The extent of lockdown and other activities instigated during the early stages of the virus varied appreciably across countries, leading to differences in observed morbidity and mortality rates.[12],[13],[14],[15] For instance, comprehensive measures introduced early among several Asian countries, including Korea, Malaysia, Taiwan and Vietnam, as well as among several African countries, including Ghana, Malawi and Namibia, limited the number of deaths certainly when compared with Western European countries, including Italy, Spain and the UK.[13],[14],[15],[16],[17]

As a result of the pandemic, traditional face-to-face teaching–learning instructional methods for HCP students could no longer continue cognisant of the safety of both educators and students.[11],[18],[19] This caused concern, certainly among faculty staff and students in several countries, since conventionally medical, dental and allied health professional education had been through campus-based educational activities.[20] Typically, the teaching of HCPs comprised face-to-face instructional sessions combined with practical sessions, observations and by hand activity through experienced clinicians or other allied HCPs.[19],[21],[22],[23],[24],[25],[26] However, teaching approaches were beginning to change before the pandemic, especially in higher-income countries, with the instigation of blended approaches, including e-learning, with studies showing potentially improved learning through such approaches.[27],[28],[29] However, there were concerns with the extra burden for both educators and students and available facilities.[30] In addition, other than campus-based formal settings such as lecture halls or in-hospital or ambulatory care health-care settings, HCP students often learn when sitting and chatting together as well as through teacher–student and peer interactions when in health-care settings. This includes taking part in social activities, all of which are also forms of face-to-face learning.[31] Consequently, the closure of universities was highly problematic, especially for medical, dental and allied health professional education with practical and hands-on teaching of cases.[32],[33],[34]

One of the top priorities for any national government should be developing and ensuring trained HCPs to manage diseases within their populations.[35] This is especially important in low- and middle-income countries (LMICs) with their increasing burden of infectious diseases along with growing rates of antimicrobial resistance (AMR), with its subsequent impact on morbidity, mortality and costs.[36],[35],[39] AMR rates are expected to grow with high rates of antimicrobial prescribing for patients with COVID-19 despite limited numbers of bacterial or fungal co-infections unless addressed.[40],[41],[42],[43],[44],[45] Potential activities to improve antibiotic prescribing and dispensing include making sure all HCPs are fully conversant regarding antibiotics and antimicrobial stewardship programmes, which is not always the case.[46],[47],[48],[49],[50] Encouragingly, Mohamad et al. showed low rates of antimicrobial use among patients with COVID-19 in the community in Malaysia, providing direction to others.[51]

Alongside concerns with inappropriate prescribing of antimicrobials and the resultant impact, there is continued growth in the prevalence of non-communicable diseases (NCDs), including cardiovascular diseases and diabetes, across LMICs, which, if not optimally treated, will increase complication rates and associated morbidity, mortality and costs.[52],[53],[54],[55] Issues of complications and their costs are especially important in LMICs where there can be high co-payment levels, as seen in many African and Asian countries, which can potentially be catastrophic for patients and their families.[56],[57],[58],[59],[60],[61] Co-payment expenditures increased at least twice as much between 2000 and 2017 in LMICs versus high-income countries, further exacerbating the situation.[62] Launching national programmes to improve the prevention and management of NCDs can reduce such expenditures. Coupled with this, minimising the number of medicines prescribed as well as physicians preferentially prescribing lower-cost multiple sourced medicines; however, this requires fully trained HCPs.[63],[64],[65]

Fully trained HCPs are also necessary to address any misinformation regarding possible treatments for patients with COVID-19 and vaccines.[66] This happened with hydroxychloroquine following early endorsement with limited numbers of patients in the initial studies, which resulted in increased mortality and costs.[14],[67],[68],[69],[70] There has also been considerable misinformation regarding vaccines for COVID-19 impacting on their uptake.[71],[72],[73],[74] Community pharmacists, in particular, can play a key role in providing symptomatic relief, discussing protective measures, including PPE, helping with vaccinations and dispelling myths.[15],[75],[74],[75],[76],[77]

The closure of universities resulted in a rapid re-think among educators regarding the teaching of HCPs especially among LMICs.[78] E-learning approaches, including live video-based classes, came to the forefront of teaching, enabling HCP students to complete their training despite university closures.[79],[80],[81],[82],[83],[84],[85],[86],[87],[88] Online learning is defined as computer-generated teaching–learning instructional methods through the Internet.[84] Several teaching–learning approaches subsequently evolved during the pandemic in addition to video-based classes as both students and lecturers adapted to this approach,[81],[82],[88],[89] which are here to stay. E-learning approaches that have evolved during the pandemic include virtual lectures, lecture capture technologies for viewing lectures in home environments, teleteaching via Microsoft Teams™ as well as the use of telemedicine for clinical teaching.[90],[91],[92],[93],[94] Encouragingly, the effectiveness of e-learning approaches has not been significantly different from traditional learning approaches.[95],[96] Having said this, appreciable barriers and concerns towards e-learning still exist. Concerns include the availability of suitable devices among students, regular access and affordability of the Internet and quiet rooms for learning.[11],[96],[97] Potential barriers for both students and educators also include ensuring that e-assessments are at least of equal standard to traditional methods and potentially more rigorous.[98],[99] Technological improvements can potentially be implemented to improve student and teacher interactions during teaching–learning alongside additional funding for disadvantaged students to address concerns.[11],[96],[100],[101]

Alongside this, there are also issues and concerns regarding changes in the mental health of both students and staff caused by the closure of universities and associated isolation. This could potentially impact on the training and knowledge of HCP students, exacerbated by reduced hands-on experiences leading to a number of issues including future job security.[96],[102],[103],[104],[105]

Higher-income countries appeared better prepared for university closure and the implications for teaching HCP students than lower-income countries; however, this was not always the case. For instance, there had been considerable investment in university education among high-income Arab countries before the pandemic. This included Saudi Arabia, where there had been appreciable investment in IT equipment to enhance blending learning before the pandemic.[106] As a result, there appeared to be a relatively smooth transition from blended approaches towards predominantly e-learning approaches using BlackBoard™, Backboard Collaborate® and Zoom® platforms for teaching, including interactive sessions and examinations, at the start of the pandemic.[106],[107],[108],[109] There was a similar situation in the United Arab Emirates (UAE), where most universities already had e-learning management systems at the start of the pandemic.[110] Early challenges were addressed by flexible approaches to teaching and the authorities working with local telecommunication companies to provide free access to online learning platforms as well as expand the bandwidth of the Internet, which resulted in high levels of trust and confidence between students and educators.[109],[110],[111],[112] Initiatives and experiences were similar among several universities across UAE.[110],[111]

This contrasts with several LMICs where students and educators struggled at the start of the pandemic with critical issues. Key issues included funding for devices and Internet bundles and a lack of familiarity with e-learning approaches.[9],[11],[84],[88],[113] This was particularly the case across Africa, although the situation improved with increased support for both students and educators.[11] There were similar concerns in Bangladesh, which are also being addressed,[114] as well as with a number of Central and Eastern European countries. These included Bulgaria, the Czech Republic, Poland and some Universities in Romania at the start of the pandemic.[115],[116],[117],[118],[119] This is now changing with increasing familiarity and good support from educators, mirroring the situation in Latvia and Slovenia.[117],[118],[119],[120],[121] Students and educators at the top universities in the Republic of Srpska (Bosnia and Herzegovina) were also generally well equipped with the necessary devices to fully implement e-learning approaches at the start of the pandemic alongside affordable Internet facilities, with students usually ready to accept e-learning as a new educational model.[110] Overall, there was a comprehensive approach at the University of Banja Luka in the Republic of Srpska at the start of the pandemic to rapidly instigate e-learning approaches, which were well received by the students.[110]

A recent pilot study in India also identified a number of issues and challenges for both HCP students and educators at the start of the pandemic.[122] These included a lack of devices and equipment alongside a lack of familiarity with e-learning approaches at the start of the pandemic among some students, combined with issues of Internet connectivity and affordability of Internet bundles.[122] This is starting to be addressed, with the findings of the pilot study in India being taken forward to help further guide university personnel and authorities in future pandemics. Similar challenges and issues have also been seen in Malaysia, with this research also being taken forward to further guide approaches to enhance HCP education in Malaysia and wider during this and future pandemics.

In conclusion, innovations with e-learning approaches will continue with blending learning here to stay. This is being enhanced by universities and governments seeking to address the challenges, including available devices and Internet bundles. Alongside this, there will be continuing research to improve online learning approaches and experiences as well as address recognised difficulties relating to practical and clinical clerkship and rotations together with the integrity of examinations. Alongside this, there will be ongoing research to help mitigate the psychological and emotional health consequences of COVID-19 and lockdown measures among academic staff and HCP students, which can be considerable.[123],[124],[125],[126] Hopefully, these combined activities will play a critical role among medical doctors, dentists and other HCPs in handling progressively complicated patients in the coming years. We will continue to monitor the state of affairs and suggest future initiatives where pertinent.


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