Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : JC01 - JC05 Full Version

Online Biostatistics Teaching to Medical Undergraduates by Comparing Google Classroom Module with Online Lecture during COVID-19 Pandemic: An Educational Interventional Study

Published: June 1, 2023 | DOI:
Sabitha Rose Jacob, Tom Wilson

1. Assistant Professor, Department of Community Medicine, Government Medical College, Manjeri, Kerala, India. 2. Assistant Professor, Department of Community Medicine, Government Medical College, Manjeri, Kerala, India.

Correspondence Address :
Dr. Sabitha Rose Jacob,
Assistant Professor, Department of Community Medicine, Government Medical College, Manjeri, Vellarangal-676121, Malppuram District, Kerala, India.


Introduction: Coronavirus Disease-2019 (COVID-19) lockdown was an opportunity for starting online medical education in Kerala, India. It was a challenge to teach the core competency biostatistics online considering the unfamiliarity and possible network issues.

Aim: To assess the learning and student satisfaction of biostatistics teaching, by comparing Google classroom module and online lecture, while teaching phase-2 Bachelor of Medicine, Bachelor of Surgery (MBBS) students.

Materials and Methods: This was a randomised educational interventional study done in the Department of Community Medicine, Government Medical College, Manjeri, Kerala, India, from December 2020 to September 2021. A total of 89 students of phase-2 MBBS were randomly divided into two groups as online lecture group and Google classroom group and five sessions were conducted. For the lecture group, classes were conducted via Google Meet using PowerPoint presentations and for the other group, PowerPoint with audio and worked-out examples were provided in Google classroom. Immediate and retention scores of academic performance and satisfaction level were assessed using Multiple Choice Questions (MCQs). Mann-Whitney U test using Statistical Package for the Social Sciences (SPSS) software version 28.0 were done for analysis.

Results: Of total 89 students participated, the mean age of the study population was 21.2±0.73 years, and there were 62 (69.7%) females and 27 (30.3%) males. Academic performance was similar for both groups in most of the immediate assessments, except activity on making graphs (p-value=0.001). In delayed assessment using median scores, the Google classroom group (110, IQR: 100-140) performed significantly better compared to the online lecture (100, IQR: 60-130) with (p-value=0.042). Regarding satisfaction, 68.3% of Google classroom students were satisfied, compared to 52.4% of the online lecture group. The flexibility to learn at own place, pace, and time was the main advantage of the Google classroom, while the need for self-motivation was the disadvantage. Direct interaction was the advantage of online lectures and inability for simultaneous doubt clarification and to attend at fixed timing was the disadvantage.

Conclusion: Online teaching of biostatistics was effective and student satisfaction level was good. Google classroom module can be considered as a supplement for traditional teaching.


Coronavirus disease-2019, Google meet, Medical teaching, Online education, Satisfaction, Statistics

With the COVID-19 pandemic, the whole world went into a lockdown with a great impact on medical education (1). All the universities including medical colleges were closed. To provide a better standard of clinical care, the trained doctors require a reasonable mix of knowledge and skill, and the skill needs to be cemented on the foundation of knowledge and these skills are taught through preclinical and clinical periods (2),(3).Traditional teaching of these skills is a tough task considering variations in the learning environment, learning capacity and attitude of students, uneven distribution of resources, lack of uniformity in course content delivery, and traditional curricula lacking innovative approaches (4).

Having the necessity to continue the course during COVID-19 time, medical teaching also became online after the initial confusion and it was tougher with competency-based medical education (5),(6). Even in the pre-COVID-19 era, well-designed online medical education courses seemed to offer similar or superior knowledge gains compared to traditional teachings in other countries, the barriers noted were limited time, infrastructure constraints, lack of co-operation and expertise from faculty and absence of institutional strategies (7). A recent review after the COVID-19 pandemic identified various challenges posed by online education in the current medical curriculum, faced by both faculty members and students, especially under the light of the competency-based undergraduate curriculum for Indian medical graduates. Among all subjects, biostatistics is one of the core competencies in a competency-based medical curriculum which is considered a necessary evil by the students (8). It is thought to be a complex topic that is characterised by hierarchically organised counter-intuitive concepts, which focus on critical appraisal skills rather than on the ability to analyse data (9),(10).

A study done in the early COVID-19 period in a western country recognised that, though online education is favourable for medical statistics, it cannot substitute the unique value of teaching and knowledge exchange through personal interaction (11). Another South Indian study also observed that, online medical teaching is effective (12). In COVID-19 setting, live demonstration classes were replaced by online lectures using PowerPoint presentations delivered through virtual platforms like Zoom, Google Meet, and Computer Information System Company (CISCO) Webex. Even in well-established settings, online education reported a lack in student retention (13). In American perspective, online synchronous teaching was perceived as effective with the main disadvantages identified as network issues, lack of suitable learning environment, and absence of face-to-face interaction (14). An asynchronous self-learning module can be considered as an alternative as used in online courses. Here, authors prepared a module on basic biostatistics topics and delivered it through an asynchronous platform namely Google Classroom. To the best of authors’ knowledge, such comparative studies on teaching medical statistics by online lecture versus Google Classroom modules have not been published so far. So, the present study was conducted with the primary objective of assessing the academic performance and student satisfaction in learning biostatistics by Google Classroom module, compared to online lectures.

Material and Methods

This was a randomised educational interventional study conducted in the Department of Community Medicine, Government Medical College, Manjeri, Kerala, India, from December 2020 to September 2021. The study was done after ethical clearance from the Institutional Ethical Committee (IEC GMCM/73 dated 28/01/2021) and informed consent was taken from students.

Inclusion criteria: All 89 students of 2018 batch having phase-2 clinical posting in Community Medicine who gave consent were included in the study.

Exclusion criteria: Students who did not give consent for the study were excluded from the study.

Sample size calculation: Based on findings from 30 sampled pilot study, using 95% (CI) and 80% power the mibnimum sample size required in a group was calculated as 37. Due to the COVID-19 crisis, batch-wise postings were not possible and all the sessions were taken as two groups for the whole batch. Students were randomly divided into two groups using a computer-generated random number table, with 44 students in Google Classroom and 45 attending online lectures. The flowchart of the study participants and the procedure has been given in (Table/Fig 1).

Study Procedure

Fourth-semester basic biostatistics topics were divided into five sessions. The sessions were types of variables in statistics, data presentation methods, demonstration of data presentation, measures of central tendency, and measures of dispersion. The online lecture on these topics was delivered through Google Meet using PowerPoint presentations during morning hours between 9 am-12 pm. Same PowerPoint presentations with recorded audio were prepared and posted in Google Classroom group on the same day of a lecture class. The PowerPoint handouts in PDF were also made available in Google Classroom with the same worked-out examples and lecture notes. All lectures were pre-recorded by the investigator and were reviewed by senior faculty members. The videos were available for students in the Google Classroom for 24 hours. As there was a continuity in topics, cross over was not done. At the end of the initial posting, all students were enrolled in Google Classroom.

Assessment of learning of each topic was done on the next day using time-limited Google Forms quiz. The assessment was done after prior intimation and it was communicated that it will not be considered for internal assessment for university exam purposes, but for learning improvement only. The assessment was done six times, by using time-limited Google Forms quizzes with no negative marks. There were five immediate assessments, which were done after each session and a delayed assessment after seven months. Assessment-1 was on the topic-terms in biostatistics and types of variables. Assessment-2 was on data presentation methods and the Assessment-3 was on the demonstration of making appropriate graphs for given data set. Assessment-4 was on measures of central tendency and the Assessment-5 was on measures of dispersion. Assessment-6 was on retention of knowledge was done after seven months covering all five topics and was announced 30 minutes before the assessment. Each assessment except the 3rd had 10 MCQs and the Assessment-6 contained 15 questions which were prepared by the investigators and were validated by senior faculty of department. Maximum score for six assessments were 100, 100, 30, 100, 100 and 150, respectively. Assessment-3 on drawing graph was evaluated manually by the investigator.

The present study assessed the effectiveness of learning by comparing the proportion of students who scored both 50% or above and 80% or above in both groups and the change in percentage scores from initial assessments to delayed assessment.

Student’s perception was assessed using an anonymous Google Forms prepared based on concepts of Kirkpatrick’s model of evaluation, where level one and two were applicable in the present study (15). The areas included were “stimulated my interest in the topic, helpfulness of the method for understanding concepts and satisfied with the teaching method”. Each was assessed using a five points Likert scale of agreement namely strongly agree, agree, neutral, disagree and strongly disagree with strongly disagree at point 1 (16). These three items were valid at level of significance at 0.05 with Cronbach’s Alpha of 0.716. The future preference of the method to learn statistics was assessed by MCQ. The percentage response for each level of agreement was calculated. The data on positive and negative points of each method were collected by open-ended questions in the Google Forms.

Statistical Analysis

The data were exported and analysed using SPSS software version 28.0. For statistical analysis, assessment scores and percentage responses to questions on perceptions were used. Academic performances of each group were compared by using the median scores of each group by Mann-Whitney U test. Authors also analysed the difference in the proportion of students in each group who scored more than 50% marks and 80% by Chi-square test. Likert scale perceptions were assessed as proportions and compared by Chi-square test. A p-value of <0.05 was considered statistically significant.


A total of 89 students participated in the study. Mean age of the study population was 21.2±0.73 years. Age ranged from 20-23 years. There were 62 (69.7%) females and 27 (30.3%) males. Gender distribution was similar in both groups with 31 females in each group and 14 males in lecture group and 13 males in Google Classroom group. Regarding previous educational background, 59 (66.3 %) studied in Kerala state syllabus and 28 (31.3%) were from Central Board of Secondary Education. One student was from Indian Certificate of Secondary Education and one from Karnataka state board. Nearly 90% of them were attending classes through mobile phones. The basic information of both groups was comparable in gender distribution and background. The difference was not significant (p-value=0.52). For the first assignment, participation was less with 72 (83.7%) students. Later, it increased to almost full participation. The number of students participated in Assignment-2, Assignment-3, Assignment-4, Assignment-5 and Assignment-6 were 86 (96.6%), 69 (77.5%), 88 (98.9%), 89 (100%) and 87 (97.8%), respectively. Participation was lowest (77.5%) for the assessment of manual creation of graphs, compared to MCQ which were easier to attempt.

I. Assessment of academic performance: Students’ group-wise

median scores for each assessment were analysed. Authors calculated and compared the median score for each assignment. For the first assessment, a higher score was obtained for Google Classroom. For Assessment-3 and 5, a higher score was obtained for the lecture group. For Assessment-3 significantly higher score was obtained for the online lecture group. For delayed assessment, the median score was higher for the Google Classroom group. These differences were statistically significant by Mann-Whitney U test, as shown in (Table/Fig 2).

The effectiveness of teaching methods lies in helping students to perform for qualifying internal exam, which is usually 50% marks. Comparison of the proportion of students who scored both 50% or above and 80% or above among two groups is shown in [Table/Fig-3,4]. There was a difference in performance based on topic, but no specific trend was observed. Taking 50% as pass criteria, both methods were effective to make students cross the eligibility criteria. The lowest performance was 77.5% for creating graphs by Google Classroom. The change in scores was also compared. The percentage of total score of first five assessments and late assessment were calculated as given in (Table/Fig 5). Change in percentage score was calculated. The median of percentages were compared between both groups. Though the change was positive for Google Classroom, there was no statistical significance.

II. Student satisfaction: As participation was voluntary the response to feedback question was sent by 41 students of Google Classroom and 42 students of online lecture group. Regarding the response to satisfaction, despite some neutral responses, agree and strongly agree responses were more compared to disagreement. The pattern was similar for both groups, but Google Classroom had more positive responses. A 56% agreed that teaching in Google Classroom made them interested in the topic compared to 30.9% of lecture group. A 43.9% found teaching through Google Classroom helped them to understand the topic, while 33.3% was the agreement in lecture group (Table/Fig 6). Though general satisfaction with teaching method was similar for both groups, a significantly higher percentage strongly agreed with satisfaction level regarding Google Classroom. A total of 68.3% of Google Classroom students were satisfied, compared to 52.4% of the online lecture group. Another question was about their preference for the particular method for learning statistics in the future with options yes, no and may be. For this too, the response “may be” was opted by nearly equal number proportions (41.3% versus 43.2%). Online lecture was less (13.6%) preferred compared to the Google Classroom module (43.5%) which is shown in (Table/Fig 7). The difference in students’ preference was found statistically significant when tested with Chi-square test with a p-value=0.003.

Authors further explored the positive and negative points regarding each teaching method as an open-ended question. This provided a better insight into learning, from a student’s perspective and how the transition to online teaching affected them. The most frequent positive response about Google Classroom was the provision to attend classes multiple times and at their convenient time and place and pace of learning. They appreciated the availability of videos and class notes to look back on, if in doubt. Another advantage pointed out is that they can take a break if it becomes tiring. Connectivity issues were less reported as there was flexibility in watching time.

Students feedback on learning methods: Comment by a student “students can access classes at any place, any convenient time. They can take their own time to read and understand. Assignments improve understanding. Files are provided in a well-ordered manner, studying becomes ordered and systematic. Students can refer to videos and documents containing the instructions provided in the classroom while trying to create charts as many times as they want, which is not possible in a simple online video lecture class”. Negative feedback was that simultaneous doubt clarification is not possible and they had to spend more time clarifying it on their own. Lack of interpersonal interaction was perceived as another issue. Other comments were on learning behaviour. Some found it difficult to learn the subject of statistics alone and to self-motivate for learning. The flexibility of time made some postpone it forever and finally miss it, which encourages a monitoring from teachers side.

III. Feedback on the online lecture method to learn biostatistics: The positive feedback on the online lectures was the direct online interaction which helped in better understanding. They felt hearing is better than reading and it is easier to learn, if someone is there to walk through with the help of videos. Negative feedback was on the timing of the class, both in terms of duration and relative early hours to learn from the home environment. Net connectivity issues interrupted sessions in between that affected understanding of new concepts and thereby, made to lose interest in learning.

A student’s comment: “It is not that online lectures are not effective. I can not concentrate on this small screen for more than 10 minutes. I could not follow any of my online clinical postings. Any method other than offline classes is a big ‘No’ for me. All teachers doing great with their lectures. It is too straining for my eyes and I also got back pain with this. I started wearing glasses. I’m done with this online mode. I request you to open college as soon as possible and shift back to offline mode. These online classes are draining me out”.


The study comparing the effectiveness of online lectures with the online module in Google Classroom in teaching biostatistics to undergraduates demonstrated that both methods were effective in imparting knowledge on all selected topics. The proportion of students who scored above selected cut-off percentages was also similar among both groups. The retention of knowledge after months was also remarkable and comparable. Though not fully agreed upon, a high level of satisfaction was expressed by students of both groups in considering the COVID-19 scenario. Regarding future preference for the online methods to learn statistics, Google Classroom had a better preference. From students’ written feedback, it is understood that in resource-restricted setting, the online module is inadequate to motivate and retain the interest of majority of students, despite the advantage of learning at their own pace, place, and convenient timing.

Articles comparing the effectiveness of Google Classroom module with online lectures, while teaching medical statistics were not much available. A South India based study published in the early 2020s among private and government medical students of Kerala and Tamil Nadu, India on attitude and factors affecting online medical education had comparable observations like 94% resorted to mobile phones for learning. Learning at leisure was the top reason why students liked online classes, whereas network problems and lack of sufficient interaction was the top reason, why students disliked them. More than half of the students did not want to continue online classes after COVID-19 lockdown as per their findings (12). As the present study compared two online methods rather than comparing with traditional teaching, students preferred Google Classroom over online lecture.

One randomised study from India which compared onsite training of biostatistics and research ethics with online course among scientist volunteers observed that, there was marked and similar improvement in knowledge immediately and three months after the course completion among both groups as observed in the present study (17). Contrary to their observation, in the current study late assessment scores were higher for Google Classroom group, the reason could be that they have learned on their own and the late assessment questions were from must-know areas only. Authors also compared the change in score from cumulative assessment to late assessment and found that the change was higher for the Google Classroom group which can be due to the opportunity to reinforce learning in Google Classroom later. One meta-analysis involving 124 online interventions on courses related to different areas of health research also demonstrated a gain in knowledge and skills (18). One of the studies before the COVID-19 pandemic had the observation on digital learning that students extensively used digital sources for self-directed learning most commonly before the examinations, so availability of learning modules will be of great help there (19).

The present study also compared students’ satisfaction with both methods. In a cross-sectional survey by AlQhtani A et al., level of satisfaction was either high or neutral when online teaching was compared to class room teaching (20). In the present study, both group gave similar levels of agreement on areas of stimulating interest in learning, helping to understand concepts and satisfaction with the particular teaching method. A Polish study among medical students about online medical education during the COVID-19 pandemic, also identified the main advantages of online learning as the ability to stay at home (69%), continuous access to online materials (69%), learning at own pace (64%), and comfortable surroundings (54%), just as the current study observations. The majority of respondents chose lack of interactions with patients (70%) and technical problems with Information Technology (IT) equipment (54%) as the main disadvantages. There was no statistical difference between face-to-face and online learning in terms of opinions on the ability of the learning method to increase knowledge (p-value=0.46). E-learning was considered less effective than face-to-face learning in terms of increasing skills (p-value <0.001). Yet the study which included medical students from different backgrounds and phases of medical teaching rated the online teaching as an enjoyable experience in spite of the their characteristics (21). Another systematic review on e-learning identified internal factors like poor engagement, poor perception and motivation, lack of students’ self-discipline and low efficacy, as barriers of online learning as pointed by the present study students (22).

Medical curriculum of India envisages the role of life learner as one of the prime role of Indian medical graduates. To achieve that role, one needs to be trained in self-directed learning (23). While planning online Continuing Medical Education (CME), one needs to consider this factor, that qualitative study among practising physicians finding lack of self-discipline is an important barrier in completing online learning (24). If any revolution of complete online medical education for all is to come, it is still far from a reality. Self-motivated and capable students can perform well in any platform. It is evident that students with weak academic backgrounds and other risk factors struggle most in fully online courses, creating larger socio-economic gaps in outcomes than those in traditional classroom environments (14).


The present study had some limitations in terms of absence of cross over and topic selection for online education. It is debatable whether, biostatistics is an ideal subject for assessing effectiveness of online medical education. Here assessment of learning was done by MCQs, which may not be sufficient to assess higher levels of cognition of all topics.


Within the limitations, the present study concluded that online medical education was a great help in imparting knowledge during the pandemic crisis, with Google Classroom giving a better gain in knowledge and more satisfying learning experience. It cannot substitute traditional teaching with definite interpersonal interaction, but can supplement always. The conclusion would be that though online learning can assist medical education in many aspects, it cannot solve many inherent issues in teaching and learning and it is effective in low resource setting to impart knowledge for those motivated students. Thus, the authors conclude that online learning module will definitely have a part to play in lifelong learning of Indian medical graduates. The success for the medical educator lies in ensuring engagement with the learning, whether it is an online teaching or offline teaching.


Qarajeh R, Tahboub F, Rafie N, Pirani N, Jackson MA, Cochran CD. The effect of COVID-19 pandemic on US medical students in their clinical years. Int J Med Students. 2020;8(2):172-74. [crossref]
Dhaliwal U, Supe A, Gupta P, Singh T. Producing competent doctors- The art and science of teaching clinical skills. Indian Pediatr. 2017;54(5):403-09. [crossref][PubMed]
Sahu PK, Chattu VK, Rewatkar A, Sakhamuri S. Best practices to impart clinical skills during preclinical years of medical curriculum Website: J Educ Heal Promot. 2019;8:57.
Solanki A, Kashyap S. Medical education in India: Current challenges and the way forward. Med Teach. 2014;36(12):1027-31. [crossref][PubMed]
Stoehr F, Müller L, Brady A, Trilla A, Mähringer-Kunz A, Hahn F, et al. How COVID-19 kick-started online learning in medical education-The digimed study. PLoS One. 2021;16(9):e0257394. [crossref][PubMed]
Nimavat N, Singh S, Fichadiya N, Sharma P, Patel N, Kumar M, et al. Educn 2. Adv Med Educ Pract. 2021;12:237-43. [crossref][PubMed]
O’Doherty D, Dromey M, Lougheed J, Hannigan A, Last J, McGrath D. Barriers and solutions to online learning in medical education-an integrative review. BMC Med Educ [Internet]. 2018;18(1):130. Available from: s12909-018-1240-0. [crossref][PubMed]
Miles S, Price GM, Swift L, Shepstone L, Leinster SJ. Statistics teaching in medical school: Opinions of practising doctors. BMC Med Educ [Internet]. 2010;10(1):75. Available from: [crossref][PubMed]
Astin J, Jenkins T, Moore L. Medical students’ perspective on the teaching of medical statistics in the undergraduate medical curriculum. Stat Med. 2002;21(7):1003-06. [crossref][PubMed]
MacDougall M, Cameron HS, Maxwell SRJ. Medical graduate views on statistical learning needs for clinical practice: A comprehensive survey. BMC Med Educ. 2019;20(1):01-17. [crossref][PubMed]
Rota M, Peveri G, Fanelli M, Torelli L, Rocchi MB, Specchia C. Satisfaction with online teaching of medical statistics during the COVID-19 pandemic: A survey by the Education Committee of the Italian Society of Medical Statistics and Clinical Epidemiology. Teach Stat. 2021;43(3):129-39. [crossref][PubMed]
Thomas A, Shenoy MT, Shenoy KT, Kumar SS, Sidheeque A, Khovidh C, et al. Survey among medical students during COVID-19 lockdown: The online class dilemma. Int J Med Students. 2020;8(2):102-06. [crossref]
Poll K, Jeanne Widen Me, Weller S. Six instructional best practices for online engagement and retention. J Online Dr Educ ISSN Online. 2014;1:2330-4391.
Baum S, McPherson M. The human factor: The promise & limits of online education. Daedalus. 2019;148(4):235-54. [crossref]
Heydari MR, Taghva F, Amini M, Delavari S. Using Kirkpatrick’s model to measure the effect of a new teaching and learning methods workshop for health care staff. BMC Res Notes [Internet]. 2019;12(1):01-05. Available from: https://doi. org/10.1186/s13104-019-4421-y. [crossref][PubMed]
Sullivan GM, Artino AR. Analysing and interpreting data from likert-type scales. J Grad Med Educ. 2013;5(4):541-42. [crossref][PubMed]
Aggarwal R, Gupte N, Kass N, Taylor H, Ali J, Bhan A, et al. A comparison of online versus on-site training in health research methodology: A randomized study. BMC Med Educ. 2011;11(1):01-10. [crossref][PubMed]
Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: A meta-analysis. JAMA [Internet]. 2008;300(10):1181-96. Available from: 300.10.1181. [crossref][PubMed]
Scott K, Morris A, Marais B. Medical student use of digital learning resources. Clin Teach [Internet]. 2018;15(1):29-33. Available from: tct.12630. [crossref][PubMed]
AlQhtani A, AlSwedan N, Almulhim A, Aladwan R, Alessa Y, AlQhtani K, et al. Online versus classroom teaching for medical students during COVID- 19: Measuring effectiveness and satisfaction. BMC Med Educ [Internet]. 2021;21(1):452. Available from: [crossref][PubMed]
Ba? czek M, Zagan´ czyk-Ba? czek M, Szpringer M, Jaroszyn´ ski A, Woz? akowska- Kaplon B. Students perception of online learning during the COVID-19 pandemic: A survey study of polish medical students. Medicine (Baltimore). 2021;100(7):e24821. [crossref][PubMed]
Regmi K, Jones L. A systematic review of the factors-enablers and barriers- affecting e-learning in health sciences education. BMC Med Educ. 2020;20(1):91. [crossref][PubMed]
Peine A, Kabino K, Spreckelsen C. Self-directed learning can outperform direct instruction in the course of a modern German medical curriculum-Results of a mixed methods trial. BMC Med Educ [Internet]. 2016;16(1):01-11. Available from: [crossref][PubMed]
Gagnon MP, Légaré F, Labrecque M, Frémont P, Cauchon M, Desmartis M. Perceived barriers to completing an e-learning program on evidence-based medicine. Inform Prim Care. 2007;15(2):83-91.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/60406.18116

Date of Submission: Sep 26, 2022
Date of Peer Review: Jan 20, 2023
Date of Acceptance: Apr 13, 2023
Date of Publishing: Jun 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 27, 2022
• Manual Googling: Feb 16, 2023
• iThenticate Software: Mar 22, 2023 (7%)

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