Covid-19: e-Learning as a tool for improving the knowledge e-learning

Introduction: Preventing and fighting COVID-19 are of the utmost importance. In this context, the importance of using telemedicine tools has grown, including teleconsultations, epidemiological telemonitoring, remote diagnosis, support, and training of health professionals. Objective: This article aims to report the results of a distance-training course on SARS-CoV-2 and COVID-19. We analyze the course adherence, the students’ profile, pre, and post-test proficiency index and satisfaction with the course. Methods: This is a cross-sectional study that evaluated data from the course on SARS-CoV-2 and COVID-19. The data were analyzed in terms of distribution and comparisons of means and frequencies. A paired t-test was used to compare the pre and post-test grades. A p-value <0.05 was considered significant. Data were collected from the Moodle teaching platform, without identifying the participants. Results: From March 23 to May 14, the course was offered to 1,008 medical students and health care providers. Most were from the state of Minas Gerais, some from other Brazilian states, and Mozambique. The majority completed the course, with an 89.8% adherence. The evaluations related to the course, the tutors, the degree of satisfaction, and the security for the professional performance after the course obtained maximum scores. The comparison between the pre and post grades showed proficiency gain (p<0.0001). Conclusion: The course has contributed to the training of medical students and health professionals from Brazil and Mozambique. The organizing committee was able to prepare students and provide knowledge to professionals with difficulty to access good technical and evidence-based information. After the training, the students were selected to work on university projects aiming at supporting city halls, health departments, and the community.


INTRODUCTION
At the end of 2019, the severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV-2) was identified as a cause of respiratory infections in Wuhan, a city in China's Hubei province. In February 2020, the World Health Organization (WHO) termed the disease caused by SARS-CoV-2 as coronavirus disease 2019 (COVID-19) 1 . On March 11, 2020, the WHO declared a pandemic 2 .
Chatterjee et al. 3 (2020), emphasize the importance of preventing, and fighting the disease, by strengthening health systems, preparing the community to respond to the situation, and promoting the safety of the populations' health worldwide 3 . Information and communication technologies have become important means to support patient care, the community, health services and institutions. Vidal-Alaball et al. 4 (2020) reported the importance of using telemedicine tools at this time of the pandemic, including teleconsultations, epidemiological, and patient telemonitoring and training of health professionals.
In March 2020, the Federal University of Minas Gerais (UFMG) created a Central Committee to Fight against Coronavirus with several representatives. The main objective is to organize university teaching, assisting, and research actions to support the community in their fight against the pandemic through scientific and technical support. Social isolation measures were adopted, and face-to-face classes were suspended 5 . The Health Campus local committee organized a training course for nursing and medical students using a virtual teaching environment. After the training, the students can work with university assistance projects to support public health, and the community of municipalities in our state.
The course was offered via the Moodle © platform of the Health Informatics Center (CINS) of the School of Medicine of UFMG 6 . The article aimed to show the results of the course, to analyze the participants' profile, the proficiency index in the preand post-test, students' adherence, and students' satisfaction with the course.

METHODS
This is a retrospective and cross-sectional study, using an institutional database without identifying the users. Only the data are analyzed following the General Data Protection Law N. 13.709/2018 and CONEP Resolution 510 (April/2016).
To prepare the course (Fighting the SARS-CoV2 epidemic: Training health students from UFMG to answer the population's questions), a group of teachers and students discussed the format, selected topics, accessed materials, types of tutoring, and evaluation. The initial objective was to train medical and nursing students to work on a project at the UFMG School of Medicine to answer the population's questions about the disease with individualized responses to health professionals and to the general population 6,7 .
Shortly after that, other university assistance projects were developed, including "Adopt your neighborhood in times of coronavirus" in partnership with community associations, city halls and municipal health departments. Students, supervised by university teachers, started to assist in the production of didactic materials, podcasts, and information via radio shows; providing instructions to create homemade masks and face shields; in collecting epidemiological data; in supporting health barriers, as well as acting in information services via mobile use. Before starting the course, the student must answer a profile questionnaire and take a pre-test. In the end, the student answers a satisfaction questionnaire, and takes a post-test.  Table 1.  Adherence to the course was also assessed; of the total enrolled, 872 (87%) were students, of which 54 (5%) never accessed the teaching platform and 82 (8%) did not finish the course. Regarding participation, Table 2 shows data on the percentage of students who completed the course, the reasons for not having access to all of the available material (when applicable) and the evaluation of the interaction through the forums.
The assessment of the tutors' performance, as support for students, is shown in Chart 2, based on the answers to two questions.
When assessing whether the participants felt secure to answer the population's questions after the training, more them 90% of the participants totally agreed with it. In addition, when participants were asked about the identification of the signs of disease severity , more than 90% of them totally agreed that after the course they would feel more comfortable doing it.
When assessing the overall learning from the course (Chart 3) and the fact that the acquired knowledge provided them with greater security in clinical practice, over 90% of the participants strongly agreed with it.     According to the WHO (2019), "health literacy represents cognitive and social skill factors that determine the motivation and ability of individuals to gain access to, to understand and use information so that they can promote and maintain good health" 13 . Research shows that the WHO is a respected source of information during epidemics, suggesting that the organization has many resources to stimulate health behaviors 14 . Similarly, but on a much smaller scale, we can say that UFMG is a respected source of information. The demand for our course was high, due to the participants' confidence in the quality of the provided information.
The evaluation process is one of the important components in a teaching-learning process 15 . Thus, in addition to access all activities, the students needed to send the tasks and interact with colleagues and tutors. The students were also required to attain a score of at least 70% in the post-test. The authors also affirmed that primary care services need to be improved as an instrument to avoid the collapse of the health system, preventing deaths and morbidity from COVID-19 and other chronic diseases or conditions that require assistance 17 .
Adherence to the course was 83%. Only 82 students Regarding the profile of the participants, it was possible to verify that the majority is from the state of Minas Gerais, whereas some are from São Paulo and other Brazilian states, and a few from Mozambique. Kuhn et al. 19 (2017) analyzed the characteristics of students in a distance technical course. The authors reported that most participants were females (76%).
They also verified that 54.1% of the students chose a distance technical course for reasons of opportunity and that 85% were satisfied with the accessibility to the platform and with tutoring.
In addition, 88.5% were satisfied with the platform usability and 90% with the course dynamics 19 .
Online distance education allows the participants to adapt their schedules to daily life. It also provides collaborative learning through interaction networks and exchange of experiences between participants 20,21 . The degree of student satisfaction with our course was high, as well as the evaluation of the course, platform and tutoring. Tutors encouraged students to think critically and helped them to interact at the forums.
The scores regarding the feeling of security after the training to answer the population's questions, to identify the signs of disease severity and to act professionally were also very good.
In addition, participants affirmed that they would recommend this training to a colleague. As one of the limiting factors of this study, we have the fact that it is a cross-sectional study, with a relatively small sample size. Another factor is that our study included only medical and nursing students and health care providers from our country and, to a lesser extent, from Mozambique. Nevertheless, it is worth mentioning that the course provided by the WHO was also freely available to all countries. Thus, equity was valued regarding access to information, regardless of the place where the participant lives. The interaction between a public university such as UFMG and the community is essential for health services and for the dissemination of scientific information, especially in times of pandemic.

CONCLUSION
The course "Fighting against the SARS-CoV2 pandemic: Training health students from UFMG to answer the population's questions" has frequent updates, since COVID-19 is a new disease and many controversies and doubts still need clarification. The course has collaborated to train nursing and medical students, and health care providers, from various Brazilian municipalities and from Mozambique. The organizing committee was able to act quickly to prepare students who were close to the end of the medical undergraduate program to assist patients with COVID-19. Adherence to the course was high and also provided technical knowledge and evidencebased scientific information to health care providers who work at remote and places with few resources.

ACKNOWLEDGMENTS
We would like to thank all tutors (students and teachers) and

CONFLICTS OF INTEREST
The authors declare no conflicts of interest.

SOURCES OF FUNDING
The authors declare no sources of funding.