Seventy-three out of 78 educators (93.58%) have switched their educational activities to e-learning mode in a very short period, while 5 educators (6.41%) reported the temporary shutdown of all academic activities for lockdown period. Forty-five of 73 educators (61.64%) who switched to e-learning mode were familiar with it, 25 (34.24%) were neutral and 5 (4.10%) were not so familiar. Interestingly only 29 of 73 (39.72%) educators had used online teaching mode before COVID-19 lockdown period.

Thirty-one educators reported teaching with e-learning platforms only for the undergraduate program, 2 for postgraduate and 40 for both undergraduate and postgraduate programs. While switching to e-learning mode, 57 educators (78.08%) modified their intended learning objectives to make it suitable for an online session. The preparation time of 30–60min per session was reported by 33 educators (45.20%) while 40 educators (54.79%) required more than an hour for the same. Maximum i.e. 47 educators (64.38%) reported the average duration of their online session between 30 to 60min. Session of more than an hour length was reported by 20 educators (27.39%) and less than half an hour length reported by 6 (8.21%) educators. Most educators (97.26%) reported sharing of notes or reading material or recording of the online session with the students during or after the session. Sixty-one educators (83.56%) reported that they make themselves readily available over a phone call or messages for clearing doubts or solving any problem students might face during the entire lockdown period.

Tools for online teaching: All educators indicated that they have used at least one teaching method listed in the questionnaire for covering the theoretical component of the syllabus. For clinical skills training, 58 of 73 (79.45%) educators reported the use of online teaching tools as shown in Figs. 1 and 2.

Figure 1.

Graph showing the popularity of various online teaching tools for THEORY classes.

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Figure 2.

Graph showing the popularity of various online teaching tools for SKILLS sessions.

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The decision of switching to the online mode of teaching was taken after consultation with students by 62 educators (84.93%) while 11 educators (15.06%) did not get a chance to consult students as the transition was very rapid. Student's training for using online platforms for learning was facilitated by 38 educators (52.05%) while 35 (47.94%) did not give any training to students, although 15 of them believed that training was necessary. Not every online session records the student's feedback. An average of 3.42 sessions per 5 online sessions record student's feedback. The number of attendees in online sessions varies from a minimum of 5 to a maximum of 800 learners. Discounting the outlier, the mean (SD) of the number of attendees is reported as 31.41 (21.00) in an online session. Student's active participation in an online session is ensured by the number of methods as shown in Fig. 3.

Figure 3.

Graph showing techniques used to ensure active involvement of students in online sessions.

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Of the 73 responses, 39 (53.42%) had conducted the online examination, while 34 (46.57%) did not. Thirty educators (41.09%) were planning to conduct the online examination in the near future. Nine educators had conducted both theory as well as skills examination in online mode. Out of 73 educators, 43 (58.90%) favored, 23 (31.51%) were neutral on an online assessment. Seven respondents (9.59%) were not in favor of online assessment and are less likely to conduct it even in the future.

Overall satisfaction of educators on switching to online mode was 3.44 on the Likert scale of 1 (least satisfied) to 5 (most satisfied), indicating that most of the educators are satisfied with it. Positive perception is seen on being collaborative in adapting with this new normal, summarized in Table 3.

The 2020 survey questionnaire also asked six open ended questions to the educators, based on their experiences, to narrate the facilitating and limiting factors in transiting to online education, which is analyzed using qualitative thematic analysis methods. These findings are deliberated in the discussion section.

The table 4 relates the parallel findings from both the surveys, which will help us know the exact nature of the transition of the optometry education system in India. As the two surveys were done with different intentions and instruments, we do not intent to calculate statistical significance but the mere comparison will help us derive appropriate explanation for the research question under consideration (Table 4).

COVID-19 pandemic is proving to be a creative disruption with tough challenges for all educational systems.18 At the same time, there is a strong opportunity for us to adopt newer techniques that are more suitable for the present generation of learners.19 Lockdown is continued in several states in India. While some other states are starting up with the gradual and prioritized restoration of their activities. With norms of social distancing in place and the guidelines issued by UGC, the academia is likely to continue with e-learning platform at least for few more months.20 Finding from this survey suggest that long-awaited restructuring of the educational system as suggested in the model curriculum of optometry by the Ministry of Health and Family Welfares (MOHFW), India has commenced.21,22 Our 2018 survey showed that the optometry education system was a conventional classroom based system with most teaching and assessment conducted in face to face mode. The Indian teachers and students are habitual to everyday meetings and carrying out teaching-learning activities in a class. Findings of the 2020 survey suggest that more than 90% optometry institutions and educators in India have quickly adapted to E-learning mode. The trend in pedagogy for theoretical content has shifted from monotonous didactic lectures to interactive online lectures using video conferencing tools (e.g. Google meet, Microsoft teams, Zoom, etc.); reading and writing assignments are getting done using various teaching learning apps such as Goggle classroom; class-presentations are switched to uploading of pre-recorded presentations on social media platforms. Teachers are using features such as random questioning, use of chatbox, opinion polls student lead summarization of the session and more techniques to keep the learner active and engaged during live streamed online sessions. The clinical skills teaching is now not focused only on the psychomotor skills but evidence based practice, critical thinking and clinical decision making skills are also covered using case discussions. The educators are using a wide variety of online tools and apps to keep going with their teaching. Students have also become active learners by contributing to the inputs in the e-learning environment. The rapid transition looks successful in the prima fascia. Work from home culture appears to have settled in optometry educational system prompting ‘teach from home’ and ‘learn from home’ strategies. We asked educators about the facilitating and challenging factors of online education. Qualitative thematic analysis of these open ended questions in 2020 survey identified the following facilitating factors, contributing toward the seamless transition of optometry education.

Teacher related factors:

• 1.

  Millennial teachers for the iGeneration of learners- with tech-savvy generations in academia, it is comparatively easy to adapt to the e-learning environment.23 The finding that 70% of teachers are below 35 years of age, confirms the contribution of the major ground force for online content development in the success of the quick transformation. However, further subgroup analysis showed that senior faculties were also at par with millennial teachers in adoption with e-learning systems. All the faculties reported high confidence in the use of technology for educational purposes. However, they also reported limited awareness of all technology solutions and their salient features which can be used for various educational activities. And therefore, they must be formally trained for efficient usage of various tools and online pedagogy via faculty development programs.24

• 2.

  Technology at hand: There are challenges in having appropriate high-tech gadgets, computers, or laptops with every student, and even faculty.3 More often these electronic gadgets with students are shared between the siblings. With the ongoing digital revolution in India, smartphones equipped with a 4G internet connection have reached even in the remotest part of the country.25 At the same time, the development and availability of a wide variety of tools at our figure tips are assuring the feasibility of getting into online mode.26 Educators enlisted usage of platforms such as Google classroom, Google meet, MS teams, YouTube, Zoom meetings and many more, which are multi-gadget compatible. A wise choice of multi-screen supported teaching platforms and strategic use of synchronous and asynchronous teaching techniques done by educators accommodated spectrum of devices, operating systems and internet infrastructure benefiting the students, leading to a successful transition of teaching activities to e-learning mode.

• 3.

  Habitual to web resources: The 2018 survey exposed a dependency on lectures and seminars for delivering knowledge component of the curriculum. PowerPoint presentations, videos and web resources were extensively used by educators even before COVID-19 disruption. Switching to e-learning during this lockdown was readily facilitated by these resources.

• 4.

  Attitude to collaborate: The crisis situation is equally difficult for each of us. We must be able to collaborate for a wide variety of real and virtual resources with us to promote learning in the best possible way.18 Professional attitude, transparency and clarity in communication is the key to effective collaboration. Majority educators believed in collaborative efforts and started the journey for collaboration on an individual basis, without waiting for institutional support or directives. External stakeholders like industry partners, individual practitioners, researchers were also pulled in to contribute directly to academia, which brought in new knowledge and a fresh perspective of looking at optometry education.

• 5.

  Positive enthusiasm about e-learning: Number of educators reported numerous advantages of e-learning environment like the ease of conduct, convenient technique even with limited resources at hand, cost-effective, ability to adapt to the wide learning styles and choices of iGeneration learners, the possibility of innovation and ease of monitoring and documentation of teaching activities. Some of the facilitating factors mentioned by respondents include the time flexibility, the comfort of work from home, and the ability to discharge their duties even in crisis situations adding to their satisfaction level. These factors kept the motivation of teachers high in adapting to e-education mode.

• 6.

  Student related factors:

• 7.

  Tech-savvy iGeneration students: The present generation of learners has grown up with technology. Greater use of online learning activities facilitate greater engagement of the learner. Ability to learn and revise at one's own pace, being independent of place and time leads to better educational prospects.27 The forced transition to online mode is in-fact a sure GO for iGeneration learners. The students are more concerned about their education and completion of training on time.18 In this situation of uncertainty, the students are welcoming every single act which will ensure continuity of their academic activities. They are actively involved in, not merely attending the online sessions but are also actively searching and bringing the relevant online content to the session.

• 8.

  Safe learning environment: Students are allowed to ask their doubts using social or personal messaging apps that get addressed without disclosing their identity during the online class. This type of multi-channel communication between the students and teachers is helping to achieve better outcomes.27

• 9.

  Ease and comfort of attending online sessions from home without physically traveling anywhere save a lot of time and energy. Further, students can choose and attend many online sessions other than regular online classes, either live or in deferred time, organized by various national and regional associations in optometry. They get to hear and interact with many faculties, the practitioners of national and international repute, which excites them to learn more.

• 10.

  Institutional and external environment-related factors:

• 11.

  Institutional infrastructure: The use of technology, blended learning and E-learning is on the rise since about a decade.28 These are promising techniques to foster self-learning attitude in health professional students. An increasing number of institutions are encouraging the use of technology in day to day teaching as students find it enjoyable. Purposeful and effective use of blended learning is absolutely necessary for managing student-centric learning system.28 Majority of the respondents (89.74%) reported service in optometry institution running either under a hospital setup or as a department in a university. The infrastructure and administration of hospital and university are essentially different, and therefore the priorities, procedures and techniques of academic activities are different. For instance, university educators reported use of E-learning platforms developed by their own university along with other applications, while educators belonging to hospital infrastructure relied mainly upon applications from public domain. The IT support from the institution is also identified as a major factor contributing to the quick and smooth transition to online learning. However, all educators reported high confidence and satisfaction in using online teaching tools, irrespective of type of institution they belong.

• 12.

  Contribution from external stakeholders: Social media in India saw a sudden surge of inputs from nationwide optometry/optical associations and industries in the form of webinars, live streaming of panel discussions, which stimulated not only practitioners and faculties but also students to attend more and more webinars and other online educational activities. Strong numbers of live attendees and even more number of subsequent followers ranging from 200 to 4100 unknowingly resulted in positive competitive spirit among academicians, practitioners and subject experts, to conduct good quality sessions.29 This created a positive momentum of transition from a traditional educational system to a competency-based e-learning system. Many institutions equipped with better infrastructure are contributing to the development of educational modules covering various specialties of optometry practice. Students and practitioners across India are enthusiastically participating in these online sessions, developing a culture of continued education.

• 13.

  Positive attitude in the community at large about COVID 19 pandemic- a timely decision of lockdown and sincere efforts by all individuals in all sections of the community are leading to control on the spread of the virus. The situation in India is seen as much better as compared to many developed countries in terms of the spread of COVID-19, a lesser number of cases per thousand population, lesser percentage of patients requiring critical care, higher recovery rate and lesser morbidity rate.30 This has brought a general sense of confidence which is helping in overcoming the challenges.31 A positive and hopeful environment definitely has contributed directly or indirectly toward the success of this transformation. This is evident by the fact that our 2020 survey recorded more inputs to advantages and facilitating factors and listed out very few challenges faced during the transition to e-learning.

According to WHO, COVID-19 is here to stay for a long period. The health care practices are experiencing significant changes, establishing ‘new normal’ by using the technology of the next generation. The restrictions of physical contact with patients, reduction in face to face consultation, social distancing norms are some of the challenges identified in clinical skills training.12 These challenges will persist for a longer period of time as telemedicine, artificial intelligence and innovative technologies are ready to set in permanently into eye care systems.32,33 Experiential learning with direct patient exposure in already strained resources is now significantly challenged in optometry skill training. Therefore, we must find an effective long-lasting solution by incorporating blended learning in the educational system. A good mix of online and face to face learning is suggested while addressing the challenges surfaced during this initial experience. The respondents of 2020 survey enlisted the challenges of execution of online teaching such as uninterrupted internet connectivity, technical disturbances in apps, student orientation, adjusting the pace to suit most learners, restriction on a number of online sessions per day, extension of working hours and working on weekends. Few challenges related to communication, for example, no eye contact, face reading or body language reading to understand if students are following were also reported. The time and efforts required in the preparation of high quality customized, attractive and user-friendly educational material, suitable for digital delivery of optometry content was enormous. Institutional support in terms of faculty development, student's training for efficient use the technology was also lacking.

Students of the present generation are used to group learning and value peer opinion.23 Optometry students in India are young, having just completed schooling, without much experience. Most of them do not get in a job while pursuing their education and are financially and emotionally dependent on family, assuming very little self-responsibility. Therefore, educators do not believe that learners will engage themselves in self-directed learning. Further, the lockdown has imposed the challenges of solo learning on them. Hence, the total and long term transition to e-learning is challenged.

The development of dedicated online modules specific to defined areas of competency along with detailed planning of blended learning activities is required. Accessing telehealth interactions in compliment with e-learning modules can address the perceived gap in clinical skill teaching. We must move ahead from just taking online lectures to the development of more engaging and novel teaching-learning methods based on principles of adult learning.34 We must utilize this once in a lifetime opportunity where massive sudden transitions are taking place in all sectors of life. This accelerated change if continued in the direction of upcoming trends of optometry practice will fetch positive rewards in years to come.

The 2018 study was focused more on optics related subjects while the 2020 survey addresses the entire curriculum taught by optometry faculties. In India, the optometry faculties are mostly engaged in teaching applied optics, contact lenses, binocular vision and low vision subjects.35 Since the two surveys were addressing similar but not exactly the same research question, in different learning environments, with two different instruments, no direct statistical comparison was possible. But we felt that it was reasonable to see the results of the latest survey in the light of earlier one, in order to gain clarity about the journey so far from the traditional classroom system to the technology-aided competency-based educational system.