THE PERCEPTION OF TEACHING IN THE MEDICAL INTERNSHIP IN THE COVID-19 PANDEMIC

Introduction: The SARS-CoV-2 pandemic caused various transformations in society and education. Higher education institutions were forced to implement educational measures in order to safeguard the health of medical personnel and students, limiting medical practice. Objective: To describe the perception of medical interns in academic and extracurricular activities during the COVID-19 pandemic. Methods: Databases were examined with keywords and meeting the inclusion and exclusion criteria, adopting the Preferred Reporting Items for Systematic Reviews and Meta Analyses system. Results and Discussion: 150 articles were examined; 20 that did not meet the inclusion criteria were excluded; 106 were screened and 20 articles were included. Conclusion: Most students at the educational institution experience a favorable perception of online learning.


INTRODUCTION
The year 2019 saw the spread of infection with a novel coronavirus, which the World Health Organization (WHO) declared a pandemic on 11  At the end of the internship, students must submit a degree or research paper, which is evaluated and supported before a court assigned by the Faculty of Medicine of the University of Guayaquil granting the title of General Practitioner.Ultimately, the doctor must take an examination prepared by the Council of Quality Assurance of Higher Education of Ecuador, to be able to practice as a free professional in Ecuadorian territory.It is important to know that, from experiences in clinical training, contact with patients is indispensable in the training of the doctor, but the rapid spread of COVID-19 together with restrictions, such as the global lockdown, had a negative impact on education; some higher education institutions encouraged students to work on the front line during the COVID-19 pandemic (3), but problems occurred in certain places due to the shortage of personal protective equipment; limitation Digital education was used to reduce the risk of health security, which could be implemented during the lockdown (4) In Ecuador, the first case of COVID-19 was reported on February 28, 2020, when the government implemented measures required by WHO to contain the spread of the virus, including suspension of educational activities, closure of borders, social isolation; doctors, who were not yet well prepared and many were unaware of biosecurity measures, had mandatory social security thanks to the scholarship they receive from institutions that accept them for preprofessional practices.However, universities and hospitals have temporarily suspended undergraduate academic activities in hospitals using virtuality to receive such activities from their supervisors or teachers; including various teaching methods such as online learning, offline learning, mobile learning or virtual reality, we consider digital education as teaching and learning digital technologies (5).This academic activity was hampered by the low connectivity that did not allow the normal development of virtual classes, the lack of online services and the low access of patients Bibliographic reviews on education, medical students, surgery, nursing, gynecology and medicine were carried out during the COVID-19 period (6,7), but there are no known reviews carried out in medical inmates in whom this systematic review aims to describe the perceptions of medical inmates about academics and the commitment they had during the COVID-19 pandemic, filling this gap in the literature; considering that hospital inmates play an important role in patient care, but their status as a student is not a legal obligation to fulfill the role of doctor.

MATERIAL AND METHODS
This descriptive systematic evaluation was carried out in the boarding department of the Faculty of Medicine of the University of Guayaquil in the period from August to December 2022.It was a critical evaluation of the evidence on the perception of teaching in medical boarding students in the pandemic adopting the PRISMA system.Preferred Reporting Items for Systematic Reviews and Meta Analyzes) to report research results, which will provide clarity and transparency (8) The systematic search in databases from 2019 to 2022 following the descriptors in Health Sciences using the following keywords: Student of Pandemic, COVID-19 and Perception.Through, Microsoft Academic, Education Resources Information Center, Scientific Electronic Library Online, Redalyc.org,SCOPUS, PubMed, Medline, Cochrane Library and Google Academic; they were developed and adjusted in accordance with the norms of the consulted databases (9) Similarly, Y and OR Boolean connectors were used to maximize the saturation of searched terms (10), in which primary sources of publications of recent articles and secondary sources that helped us detect disclosures for this research in electronic bases were obtained.In tertiary sources, it is imperative to draw on information concerning the decrees and regulations of academic planning of some universities.
The inclusion criteria to confirm the relevance of the articles included were the following: 1. Publications of quantitative primary studies from 2019 to 2022.Exclusion criteria are presented below in this research: 1. Documents that were not relevant to the COVID-19 pandemic 2. Qualitative Articles Once the articles have been selected, the quantitative works are extracted and incorporated into a data extraction matrix in order to obtain information about the author, location, year of publication, study design, characteristics of the study population, specific teaching methods, evaluation instruments, main content of evaluation and main findings.

RESULTS
According to Moher's guidelines (8), 150 articles were found of which only 20 were included in this review.They were classified into six different stages: 1.-Place where the studies were carried out; 2.-Sample size, 3.-Educational levels 4.-Methodological variety; 5.-Modality of education and 6.-Tools used (Fig. 1)(Table 1) Of the 20 items included, eight are from the United States, three from the United Kingdom, three from China, two from Saudi Arabia, two from South Korea, one from Brazil, one from Japan and one from Israel.Sample sizes of the included articles ranged from 10 to 2721 participants, and a total of 5605 students participated in this review, including 457 nurses in 2 studies and 5148 medical students in 18 studies.As for educational levels, only one article reported all educational levels (8 undergraduate and graduate medical students).
In the 20 articles a variety of methodologies were found, such as descriptive, crosssectional, quantitative, quasi-experimental or mixed cohort studies.It was observed that, in three studies in simulation based on virtual reality (9)(10)(11), online medical training includes simulated clinical scenarios, which prevents the interruption of training and most of the participating students responded positively about the perceived quality of this training modality.
It was observed that in three teleconsultation and virtual rounds studies (12)(13)(14), students agreed with remote access teaching round technology, allowing access to clinical teaching that would otherwise not be feasible secondary to the COVID-19 pandemic.In six web-based learning studies, it was found that distance learners experienced a higher frequency of interaction than conventional learners.No technical restrictions were observed compared to conventional students who experienced a sense of boredom more frequently than remote students.In addition, improvements were noted in the clinical performance aspects.Although half of the students still have some degree of content and are mostly satisfied, there is still a lot of difficulty in obtaining personal protective equipment, which prevents students from returning to safety their practices.

DISCUSSION
Since the discovery of the novel coronavirus was reported in 2019 in a patient with atypical pneumonia in Wuhan City, China, a global economic and social upheaval has affected vocational or higher education (33)(34)(35)(36) This systematic review presents the perception of the teaching of the medical intern 11 and are mostly satisfied, but there is a great difficulty in obtaining personal protective equipment, which makes students return safely to their internships (32); as it is observed that, despite finding a satisfaction for traditional teaching with the situation of the pandemic, students had limited academic activity.
In the context of the COVID-19 pandemic, medical imaging teachers and students faced challenges and persevered in a new virtual landscape, in order to respect social isolation policies.In addition, elective radiology was implemented virtually with online resources, demonstrating that virtual radiology was a positive educational experience (23) This modality makes learning difficult because virtual imaging can be positive, but learning this subject is productive as long as the patient is present.
The effects and success factors in a work-from-home (WFH) service learning stage during the COVID-19 period enabled the creation of fundamental success factors and practical recommendations to optimize the success of activities carried out under the WFH modality (38) In one analysis, life satisfaction has been shown to be related to the level of depression and anxiety, as well as the moderating effect of psychological well-being.Despite this, it is imperative to take preventive measures to strengthen the mental health of employees in their pre-professional activities, which have also provided support during the COVID-19 pandemic.
Digital education plays an important role in distance training for nurses and in-house doctors, both remotely and in the future.The risk of bias is high and the quality of the evidence has been found to be variable.More research is needed to design quantitative studies to assess the effectiveness of independent digital education interventions for remote training of nurses or inhouse physicians to be fully emergency-ready (39) The experience of e-Leaming in a group of ophthalmology students from Jordan was evaluated and found to be positive.They considered that e-Learning would have a prominent role in the future of medical education, and proposed blended learning programs due to the lack of skills proposed by some students (40) Considering that the hybrid instructional experience in virtual and face-to-face medical students is a productive procedure.The authors showed a favorable perception of the inverted classroom methodology by medical students who studied pediatrics during the COVID-19 pandemic.Medium and long-term studies are proposed to demonstrate the methodology (41) Similarly, the medical faculty of Pakistan provided support for the use of online learning, giving importance to student-centered learning during confinement (42) In this way, we think that the Flipped Classroom is an appropriate methodology for medical interns, since it allows them to elaborate their contents at home and in the classroom they make their participation in the activities.The impact of the COVID-19 pandemic on medical students, especially women, and the year of transition from pre-clinical to clinical cycle (45) has been reported, noting that stress decreased through religious meditation (49), which carried out studies to assess satisfaction levels through e-learning.It was found that developed countries had a higher acceptance than 7.34% compared to developing countries, which stood at (5.82%) Considering that the electronic learning system is beneficial for the acquisition of knowledge, but is not appropriate for the acquisition of clinical skills and abilities.The perception of medical inmates in the pediatric cycle during the pandemic was accepted in 80% with their resident doctor, receiving good treatment and feeling supported when sharing diagnosis despite the workload they were exposed during the pandemic.The dedication of the teaching was 87%, but they felt that they had interaction with patients with classic pathologies of the specialty because they were involved with COVID complications (46) It should be emphasized that the situation of stress, religion, workload and interaction with certain diseases preferred virtuality.
The duration of the medical internship is one year of pre-professional training, so it is crucial to practice with the patient.The studies conducted did not reveal significant differences in age, sex and services of their internships in the studies conducted.The health crisis caused the absence of many professionals to access the degree or abandon their work, which was crucial for the implementation of virtual education.
Virtual education has been seen as the urgent way to deal with the consequences caused In medical schools, they helped to improve the quality of life and professional life, allowing them to finish their careers in medical schools.
Questionnaires were used in all studies to evaluate the results that made it difficult to compare the use of digital education; it was observed that options were presented in virtual teaching and that the perception of students was high, recommending the use of alternative methods dedicated to digital and hybrid learning in qualitative investigations about the perceptions of digital education in medical interns for future studies (50)

CONCLUSION
This systematic review can demonstrate perceptual views of e-learning among medical students in a resource-limited environment following an emergency such as COVID-19.After an analysis, we found that virtual education plays a relevant role in remote training among medical interns now and in the future.Most boarding school students experience a favorable perception about online learning.The overall risk of error is high in the quality of the evidence, implying a need for additional studies that contribute to high-evidence designs to evaluate the effectiveness of independent virtual education.Therefore, university educational centers should design systematic guidelines for the implementation of digital education and be prepared for emergencies.
March 2020.This caused global The Perception of Teaching in the Medical Internship in the COVID-19 Pandemic ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-18 | e08559 | 2024.3 economic and social upheaval, affecting education at all levels.Likewise, the American Association of Colleges of Physicians suggested that medical schools stop all clinical practices (2).The students of the University of Guayaquil carry out five academic rotations.The medical clinic, Pediatrics, Obstetric-Gynecology, Surgery and Community Medicine is offered in various hospital centers in zone 5 and 8 of the Ministry of Public Health of Ecuador.The activity of the Community Medicine rotation is carried out in the community through the health centers assigned to each student.These rotations are supervised by specialized doctors to obtain the skills and responsibilities due to their communication with patients, as established by the Technical Standard of the Ministry of Public Health of Ecuador.

The
Perception of Teaching in the Medical Internship in the COVID-19 Pandemic ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-18 | e08559 | 2024.4 caused various behavioral problems in doctors in training.It was the government's job to improve Internet bandwidth.

2 .
Publications showing medical students from the boarding school, graduate school or clinical internship.3.Studies that expose virtual education as a teaching alternative.

The
Perception of Teaching in the Medical Internship in the COVID-19 Pandemic ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-18 | e08559 | 2024.6 Online classes were accepted in each department, as well as self-study was longer in online education than in standard classes.Various tools were employed, such as standardized questionnaires and surveys, anonymous surveys and Likert scales.In addition, specialized examinations or instruments with high complexity, such as imaging articles, were evaluated in certain studies.

Figure 1
Figure 1Diagram for systematic reviews and meta-analysis Teaching in the Medical Internship in the COVID-19 Pandemic ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-18 | e08559 | 2024.that included simulated clinical scenarios prevented the interruption of the training and most of the participating students responded positively to the perceived quality of this modality training.2 2 during the COVID-19 pandemic and the reflective implementation of digital education for interns.Due to limitations in research design, only a few studies have compared digital education to traditional education.It was found that the modalities of independent digital education were as effective as conventional learning consistent with research(37) A study conducted in Brazil revealed that boarding school students still possess a certain level of content The Perception of Teaching in the Medical Internship in the COVID-19 Pandemic ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-18 | e08559 | 2024.

The
Perception of Teaching in the Medical Internship in the COVID-19 Pandemic ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-18 | e08559 | 2024.12The perception of medical students during the COVID-19 pandemic and their intention to return to their practices in medical students in Peru increased when confirming the safety measures and the end of mandatory social immobilization (43) However, there is uncertainty in 90% of the individuals surveyed regarding the dates of return, completion of the medical internship and the national medical examination (NAAT), where most of the respondents devoted their time in non-formal education at the NAAT.A survey of medical students in the United States on choice of specialty was conducted, and a fifth were found to believe that the COVID-19 pandemic affected their choice(44)

by COVID- 19 ,
but it has been altered by public debates(22) It was also raised in medical students in Poland that e-learning was a powerful tool to teach medical students within the implementation of the curriculum(47) Students at various levels, including medical students, residents and fellows, perceived the effectiveness of online teaching during the pandemic, in order to demonstrate the effectiveness of teaching methodology and communication skills.87.7% of students accepted the application of e-learning during the COVID-19 pandemic in Sudan, considering that it was The Perception of Teaching in the Medical Internship in the COVID-19 Pandemic ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-18 | e08559 | 2024.13 the best solution during the closure of universities due to the pandemic, despite the fact that there are many challenges such as the inhibitory factor for using electronic technologies for medical education in Sudan(48) The research of the Program For, Listen, Look, Think and Act (PEMPA), which is a Program for the Development of Reflexivity and Self-Control, was carried out in order to evaluate post COVID behavior in infants aged 5 years.Therefore, it would be relevant to incorporate this program in medical students to improve the behavior they experienced in this difficult circumstance due to COVID(49) As a result, online education has enabled the continuity of medical education during the pandemic, maximizing the benefits of face-to-face and online teaching, improving medical education in the future.Medical schools will need to strengthen team-based, problem-focused teaching by incorporating online teaching methods into traditional medical education.The research carried out in relation to virtual education in undergraduate and postgraduate medical students.

The
Perception of Teaching in the Medical Internship in the COVID-19 Pandemic ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-18 | e08559 | 2024.14 Challenges must be systematically assessed and effective strategies designed to overcome their inhibitory effects, as physician training must be in person and exclusive virtuality would not be feasible for their training.In this way, the personal and professional quality of life of doctors in training can be improved.