Supplementary Material A

Survey Questionnaire

Medical Education in the Philippines During the COVID-19 Pandemic

This is a survey on the impact of COVID-19 on medical education in the Philippines, from
the perspective of medical students. Specifically, this study aims to identify barriers to online
learning, in order to help medical schools implement programs that will bridge gaps in
knowledge and skills during the pandemic period.

The survey is open to all medical students in the Philippines, whose classes and/or clinical
rotations have been disrupted due to COVID-19. The entire survey will only take 5 to 10
minutes to complete. Participation in this survey is voluntary. You may end the survey at any
point. By answering the survey, you consent to providing your personal information to the
study investigators. The researchers will maintain the confidentiality of data and all data will
be de-identified prior to analysis.

For questions, or if you wish to withdraw your response, you may email the primary
investigator Dr. Ronnie E. Baticulon, associate professor at the University of the Philippines
College of Medicine, at rebaticulon@up.edu.ph. Thank you in advance for your participation!

*Required questions

Informed Consent *
o I have read the study description above and AGREE to participate in the survey.
o I do NOT wish to participate in the survey.

Medical Education

1. In which medical school are you currently enrolled? *

(Dropdown list of medical schools in the Philippines)

2. Indicate your student or ID number *

3. What is your year level in medical school (i.e., Med proper)? *

o First year
o Second year
o Third year
o Fourth year

4. Did your medical school suspend classes and/or clinical rotations due to the COVID-
19 pandemic? *
o Yes
o No

5. Did your medical school require and/or encourage online learning while regular
classes are suspended? *
Online learning is defined as the use of electronic technology and media to deliver,
support, and enhance both learning and teaching and involves communication
between learners and teachers utilizing online content. (Howlett et al., 2009) This

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 may be synchronous (e.g., online lectures where teachers and learners have to be
connected to the Internet at the same time) or asynchronous (e.g., teachers upload
videos or handouts to be studied by the learners at their own time and pace).
o Yes
o No
o Unsure

6. Based on your performance last semester or academic year, your grades will fall
under which of the following? *
o Among the highest 25%
o In the middle 50%
o Among the lowest 25%

Demographics

7. What is your age? *

8. What is your gender? *

o Male
o Female
o Non-binary
o Prefer not to say

9. Which of the following best describes you?

o Single, never married
o Married or partnered in a long-term relationship
o Separated or widowed

10. Do you have any children?

o Yes
o No

11. Are you on any financial scholarship (i.e., based on financial need)?
o Yes
o No

12. What is your family’s total annual income?

o Php 250,000 or less
o Between Php 250,000 and Php 1 million
o Between Php 1 million and Php 2 million
o More than Php 2 million

13. Where have you spent most of your time during the COVID-19 pandemic thus far?
o Home with family
o Dormitory or apartment near school
o Residence of friends or other relatives
o Other:

Online Learning

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14. Which of the following devices do you own? Pick all that apply.
o Smartphone
o iPad or tablet
o Laptop computer
o Desktop computer

15. Which statement best describes your Internet access at home or where you are
currently staying? *
o I don’t have Internet access and I have to go somewhere else
o Prepaid mobile data (e.g., phone, pocket Wi-Fi...)
o Postpaid subscription service (e.g., broadband, DSL...) but the connection is slow
and/or unreliable
o Postpaid subscription service (e.g., broadband, DSL...) and the connection is fast
and reliable

16. Prior to the COVID-19 pandemic, how many hours of your schedule in medical
school is officially allotted for independent learning? This refers to protected time
within school hours for self-directed learning. Do NOT include study time OUTSIDE
of school hours (e.g., when reviewing for an exam) *
o 4 hours/week or less
o 5 to 8 hours/week
o 9 to 24 hours/week
o 25 to 40 hours/week

17. Prior to the COVID-19 pandemic, how many hours do you spend studying learning
materials online? Include all forms of online learning, whether required (e.g., online
modules) or self-initiated (e.g., browsing UpToDate, MedScape, YouTube) *
o 4 hours/week or less
o 5 to 8 hours/week
o 9 to 24 hours/week
o 25 to 40 hours/week

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 18. For each item, indicate whether you agree or disagree with the given statement.*

Strongly Disagree Agree Strongly

Disagree Somewhat Somewhat Agree
I am physically and mentally capable
of studying all remaining subjects for
the semester online.
My teachers have the resources and
skills necessary to teach our courses
online.
My medical school has the
infrastructure and resources to
support online teaching.
Medical schools affected by the
COVID-19 pandemic should give a
PASSING GRADE to all their
students.
If my medical school decides to
PASS ALL medical students, I have
enough time and resources to prepare
myself for the next year level.

19. In your opinion, which of the following activities may be transitioned fully to online
learning, while still achieving the same learning outcomes? Check all that apply.
o Lecture
o Laboratory work (e.g., anatomy, histology, pathology)
o Small group discussion (e.g., case-based discussion)
o Demo-return demo (e.g., physical exam)
o Patient encounter or bedside preceptorial
o Written exam (e.g., quizzes, unit tests, module exams)
o Research work

20. The following may be considered barriers to online learning for medical students. For
each item, indicate how often YOU have encountered these problems during this
pandemic period. *

Never Sometimes Often Always

Inability to adjust learning style
(include poor time management,
lack of discipline)
Lack of technical skills
Mental health difficulties
Poor communication or lack of clear
direction from educators
Unreliable or no Internet access
(include power interruption)
No smartphone or computer, or
limited access due to gadget sharing
with others

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 Limited physical space conducive to
studying
Need to fulfill responsibilities at
home (include taking care of family
members)
Need to work for extra income
Lack of basic needs (food, water,
medicine, security)

21. If there are other barriers that you currently experience or have experienced, please
enumerate them here:

22. What programs or interventions would you suggest to your medical school to help
you maximize learning during this pandemic period and prepare adequately for the
next academic year?

Volunteer Work

23. In which of the following COVID-19 relief activities have you participated? Check all
that apply.
o Solicitation of donations (e.g., food, personal protective equipment...)
o Manufacturing of personal protective equipment (e.g., face shields, masks...)
o Dissemination of health information on social media
o Volunteer hospital work in non-COVID areas
o Direct patient care of patients with probable or confirmed COVID-19
o Other:

As a token of gratitude, five survey participants will be randomly selected to receive a copy
of the book “Some Days You Can’t Save Them All” published by the University of the
Philippines Press. If you wish to be included in the raffle, please indicate your email address
below.

[END OF SURVEY]

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Supplementary Material B
This table includes illustrative examples of medical students’ responses to the question,
“What programs or interventions would you suggest to your medical school to help you
maximize learning during this pandemic period and prepare adequately for the next academic
year?” alongside the ten recommendations put forward in the Discussion section of the
manuscript.
Recommendation
Conduct a needs
assessment survey
among medical students
to identify those with
limited access to
technological resources.
Ensure open
communication channels
among administrators,
educators, and students
(e.g., through online
town hall meetings).
Whenever possible,
implement an
asynchronous mode of
content delivery with
minimal technical and
data requirements.
Create opportunities for
meaningful interaction
with peers and
educators.
During the transition
phase, maximize use of
curated online resources
that are available for free
or with an institutional
subscription. To sustain
the online curriculum,
support and train faculty
on content creation,
management, and
delivery. Invest in
technical support.
Proposed Interventions from Students
“Maybe [the schools] can identify students who are genuinely in need of assistance.”
“Offer assistance in the form of gadgets and mobile Wi-Fi/data allowances for
students deprived of resources for online instruction.”
“Better communication with each individual batch [of students] for their certain
needs.”
“I would really appreciate it if our school communicates with us clearly.”
“The medical school should communicate to the students their plans and decisions
because we are clueless on what to do next.”
“The institution should be open for discourse. They should not invalidate the call and
struggles of the student body. What’s necessary for the institution is to show the
student body the value of compassion and understanding in the field of academe in
the midst of the crisis.”
“Our school has already implemented asynchronous online learning, which is helpful
for those with unstable internet services. This allows students to study and learn at
their own pace.”
“Online asynchronous quizzes and assignments with a generous amount of time
before the deadline.”
“All study materials are uploaded and students are allowed to access them whenever
their resources would permit. When learning materials are taken down after a given
time, students with less resources are left with nothing despite having paid for the
same quality of education.”
“[Allocate] more time for the students to [have] peer-to-peer or peer-to-professor
interaction. The reason why lectures are important to be done in a classroom setup is
because there’s this human interaction factor that is more conducive for learning,
unlike in a virtual [meeting] like Zoom.”
“More than just academic learning, I think a strong mentorship program would be
appropriate as it would address not only current mental health concerns, but may also
inspire and motivate students during this time.”
“Frequent supervision with facilitator/moderator and peers.”
“I suggest that medical schools form partnerships with medical lecture applications
such as [REDACTED] to aid in our learning. Part of our tuition can be allotted for us
to have [access to] these websites.”
“Ensure that faculty are trained to deliver online classes, provide adequate learning
materials (e.g., not just PowerPoint [files] with no explanation), and conduct online
small-group discussions.”
“[Subscribe to] better servers and IT support if [the] online [learning] platform is to
be [used] again.”
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Adjust assessment “Avoid lengthy and numerous video requirements. If the requirement can be an essay
measures and other instead of a video, that would be appreciated.”
coursework, keeping
“Lessen number of academic requirements, especially creative [projects] and group
them aligned with and
work. Modify the grading system or make online assessments during this period non-
proportionate to desired
graded.”
learning outcomes.
“Limiting the requirements every week would help us be more productive and focus
on the scheduled lectures.”

Extend leniency to “Students should be given enough time to work on requirements. Students have
students who bear responsibilities to fulfill at home to help their families.”
additional
“A structured or recommended calendar that is flexible and realistic, even for those
responsibilities at home.
without [internet] access and [those who] have other responsibilities.”
“At home, my time is divided between doing household chores and taking care of my
[grandmother], unlike in school where my time is allotted for studying only. I hope
our faculty can understand the situation of their students. Not all their students are
rich and have [helpers]. Not all can spend their time during quarantine just studying.”
“[Take] into consideration that each student has [his/her] own responsibilities at
home.”

Provide proactive “Seminars for mental health.”

psychosocial support for
“Support for student’s mental and emotional health.”
the students. Develop
mental wellness “Ensure students’ welfare and prioritize their mental health. Conduct a survey and
programs. follow up with regards to the current condition of the students and their families.”
“The students’ mental health must also be considered during implementation and
scheduling of activities and exams.”

Give discounts on “Tuition discounts could actually help and mean a lot to most students right now
tuition and offer since there is actually low or no income at all due to the pandemic.”
scholarships to cushion
“Reduce fees significantly if online learning would be the major part of achieving
the pandemic’s
learning outcomes, since students will not be able to use facilities anyway.”
economic impact.
Advocate for greater “Since we are not really using electricity, laboratories, and other [facilities] that were
subsidies from the initially included in our tuition, I hope they give us discounts next time.”
government.
Develop bridging “Ensure that a bridging program is being created for the start of the next school year.
programs and prepare That would [consist of] diagnostic evaluations and refresher [lessons] especially for
for gradual return to incoming clerks and interns. Curricula [should be] adjusted accordingly to
clinical activities. accommodate missed learning outcomes.”
Consider putting up
“I suggest they provide a safe learning space where physical distancing, wearing of
simulation laboratories
personal protective equipment, and hand hygiene can be observed to teach the
and other infrastructure
medical students about physical examination.”
that will allow face-to-
face learning with social “Written exams are better than online exams. [For this purpose] use gyms or other
distancing. large venues to accommodate students and allow social distancing, by year level and
by section with scheduled time. Laboratory works could be done by group or by year
level.”

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