Active methodologies association with online learning fatigue among medical students.

Background: Due to the current scenario of the COVID-19 pandemic and the social distancing issues, distance learning was implemented in many medical schools. Educational institutions faced the challenge of continuing to promote teaching and learning while keeping teachers and students in their homes, aiming to reduce the spread of the virus. This change compromised the students' mental health, due to the degree of exhaustion or fatigue attributed to the involvement in videoconferences, called "zoom fatigue". Despite the importance of zoom fatigue for medical education, it can be observed that there have not been studies on the role of the online teaching and learning process through active methodologies in the genesis of this fatigue. We aimed to assess the association of the teaching method used and the prevalence of zoom fatigue.

Methods: A cross-sectional, quantitative, analytical study was carried out in Medical Schools of Ceará, Brazil. Problem-Based Learning (PBL) teaching methodology is the only methodology used in the first semester and PBL together with traditional teaching, i.e., hybrid teaching, is used in the other ones. The Zoom Exhaustion & Fatigue Scale (ZEF) was used, with the questions currently validated for Brazilian Portuguese. Chi-square tests were used to verify the statistical association between the measured variables and the teaching methodology.

Results: The prevalence of zoom fatigue reached 56% in students using the hybrid model, versus 41% in those using the PBL methodology, with a statistically significant difference (p value = 0.027). The mean prevalence of overall zoom fatigue was 48%. Students using the hybrid methodology differed from PBL students by having a significantly higher frequency of feelings of wanting to be alone after a videoconference (16.9 vs. 7.1%, respectively) and needing time to be alone after a video conference (10.2 vs. 3.6%, respectively).

Conclusions: Considering that zoom fatigue may stay with us for years beyond the COVID-19 pandemic, it is important to know and provide instructions on how to reduce video conferencing fatigue. The present study suggests that the active participation of students and the number of activities are important factors to be considered.