Edmodo: An Effective Learning Management System Tool for Online Medical Education During COVID-19 Pandemic

Covid-19 is undoubtedly this century’s deadliest disease. As the preventive measures for this lethal condition involve minimization of human-to-human contact, physical classes were suspended

process of adapting to revised guidelines, 6 international students proposed that the convenience and flexibility of e-learning make it an attractive option 7 .

DISCUSSION
E-learning is a modern academic approach that ensures versatility, flexibility, interaction, group effort and collaboration among the students 8

. Learning
Management Systems (LMS) is the main medium for practicing e-learning courses in education and various other fields 9 . Most widely endorsed LMS are those that are freely accessible due to their high demand and because it includes the exchange of experience and effective feedback and check and balance mechanism 10 . Moreover, they are cost-effective for both institutes and students.
Two school employees from Illinois, USA: Jeff O'Hara and Nicolas Borg created Edmodo about a decade ago, which is now one of the leading open source LMS, having a record of 100 million users worldwide as per the 2020 update 11,12 . Its distinctive advantage is that the academic assessment tools are inbuilt and support both learners and facilitators from a remote distance. Moreover, it is user-friendly and easy to understand because its interface is relatable to Facebook. This learning medium is open source, safe and regularly upgraded with technological advancements. The advantages are depicted in Figure 1.
Edmodo can contribute to becoming a good source for facilitators to superintend alliance with students, colleagues as well as parents. As the founders were school workers they designed Edmodo as a worthwhile teacher-centered aid. As with evolving era the health care community is using internet technology at maximum, especially for educational purposes, LMS like this is considered groundbreaking concerning its wide reach and keeping up the motivation and inspiration of users 13 . Furthermore, the instructor can circulate resources, and allocate tasks, videos and fun activities at Edmodo where the participants are involved comfortable with commenting and interactive chats and they can save or submit assignments anytime, anywhere with ease. Table 1 depicts the feature in detail.
Edmodo is also found to enhance learners' encouragement towards the educational program and improve problem-solving and reasoning skills 14 . While most of the studies explored only students' perceptions of this virtual service, a study conducted in Indonesia inquired about the teacher's perspective on the strengths and weaknesses of this online educational tool. They used it in the domain of English language learning and found that it is economical, private, simple, and flexible and the demerits included increased time consumption, slow uploading due to poor internet connection or technical errors and easy imitation of classmate's assignments by some students 15 .

Figure 1: Advantages of learning management system.
A Turkish study that suggested how Edmodo can promote life-long learning, highlighted the fact that the library in which files, pictures and materials are kept, is very useful as resources used in training are organized systematically and students can use, download and share them with ease. They concluded, that it helps people achieve self-realization and enhances gratification and motivation in lifelong learning 15 .
When Edmodo was compared to other LMS in terms of characteristics and tools, namely Moodle, and Instructure; it was found to have the most academically useful features 16 . Another study compared Moodle and Jejak Bali with it and reported that it supports a wide range of websites as well as both android and iOS. Another unique feature is the Gradebook system which is a student record that is used by the instructor to give an assessment value; it implements an easy, efficient and enjoyable learning system and is antici-pated for teachers, students and parents 17 . The reasons for choosing Edmodo as per students have been its simplicity 65%, communication 31% and easy usage 4 %, Further 61% of students wanted to continue usage of this educational technology in future learning when compared with other social platforms 18 . Many medical institutes also use Google Classroom, however it does not support Microsoft Office tools which were considered a limitation that Edmodo does. Many medical students use Facebook and What's app for educational purposes, however, What's app has been proved to be highly distracted and low yield in terms of learning 19,20 . It is also claimed Edmodo has minimum to no attention diverting plug-ins and no baseless endorsements or advertisements, which makes it more education-oriented in comparison to other social networking sites 21 . Table 2 depicts detailed differences between the leading LMS and SNS.  A survey conducted on medical students at Dow

Edmodo in Medical Education
With widespread consumption of internet technology by students, it is rational to embrace it within academics 22 . Internationally students are found to use LMS to obtain organizational study information and for revising lectures and constructing exam notes 23 . Edmodo was in use even before the rise of the pandemic globally but its use was limited in medical education. However, now in the post-covid era medical education has become dependent upon online resources and many medical schools globally have welcomed the use of this virtual tool.
In an Indonesian study, 52.9% of undergraduate medical students agreed online learning process needs to use learning management systems like Edmodo 24 . A study from Poland reported Edmodo made their exam preparation easy and convenient as the study material was available with a single click throughout the semester therefore they regarded this networked learning as highly flexible 25 . An Indian medical university evaluated the role of this social network, as an aid in imparting education; they reported statistically significant changes in the academically weaker students 26 .
The use of e-learning has been reported in post-graduate training in medical education as well for example in the Ophthalmology residency program in Baltimore, the US and they concluded that the solution has been both cost-effective and productive. Residents were thoroughly satisfied and faculty utilization had been increasing 27 . A study in Canada demonstrates the solutions to the current medical education crisis, as shown in Figure 2. In addition, Edmodo has proven to be helpful for the implementation of many of these solutions 28 . University of Health Sciences, Karachi concluded satisfaction of medical students toward the e-learning environment and suggested adopting a hybrid technique incorporating a mixture of e-learning as well as practical exposure appears greatly feasible for efficacious medical education impartation. In another study at Sialkot medical college, students were assigned individual online quizzes and assignments in Edmodo and a correlation between the internal assessment of students and their performance in the 1 st professional exam was observed which turned out positive (correlation coefficient 0.74) 30 .
We have incorporated this social networking tool to practice online tests and mock exams in our institution along with Zoom for keeping a check on students' suspicious activities, further we also use it to upload lectures in the form of presentations and give assignments and quizzes to the student for monitoring attentiveness of students during online lectures. Therefore, it can be said that Edmodo is being used by Pakistani medical universities as well but very little data is available on the student's feedback and evaluation of its effectiveness.

A Source for Blended Learning (Tool for flipped classroom and gamification)
Literature reveals a list of features Edmodo possesses that makes it exclusively suitable for blended learning: fusion of LMS applications with social media, attendance, home assignments, seminars, quiz/polls, forums, certificates, document uploading, grade books, notifications, tests, scheduling, communication features with parents, emailing, and chat service. The results indicate that students can use these features well 31 . Moreover, it has some gamification features like badges, a progress tracker and also tasks and projects 32 .
A case-control study was conducted in Hong Kong on improving argumentative writing by blended learning approach and gamification via Edmodo in which the control group was taught via a direct teacher-led instruction approach while the other group was taught by online Edmodo postings and pre-and post-test written essays were held. They reported significant progress in students' writing that was taught by a blended learning approach and when gamification was implemented online contributions were significantly higher 33 .
A study in Pakistan also evaluated it as a tool for blended learning. PowerPoint presentation (PPT) containing lecture material was uploaded on Edmodo including a table of relevant resources that could be used along with a quiz then the standard method of flipped classroom was followed. The students had a favorable view of the class. They indicated high yield interaction, healthier retention, individual attention and application of already obtained knowledge can be practiced in this method 34 .

Helpful in Self-directed Learning
Self-directed learning (SDL) is an approach where learners take responsibility and self-monitor and self-manage processes to achieve their learning outcomes. Self-monitoring is dependent upon both internal and external feedback, so it builds from a collaborative process. Self-management involves shaping the contextual conditions in line with target-driven actions. This is a collaborative process between teachers and students. It is also a complicated process, and as such the development of SDL has some barriers related to the student, the organization and the teacher-student interaction.
The main task of the teacher is to develop the learning objectives and the student is supposed to make a schedule around it 35 . Fortunately, Edmodo has been proven to overcome this barrier by a Saudi Arabian study in 2017 36,37 .
Previous research has proven it as an effective tool in various higher education fields including business 38 , computing 39 , media 40 , tourism/culinary education 41 , language learning 42 and even in connecting students from two different nations (the USA and Japan) for learning language 43 and it is being proven to be as such in medicine as well. It can be applied in several aspects such as sharing course material, conducting exams and even improving physical sessions by incorporating it into flipped classroom method.

Recommendations
Literature on Edmodo usage in Pakistani Schools 44 and other educational programs including B.Ed 45 and intermediate language learning 46 has been reported positively. However, very few Medical Universities in Pakistan have reported it and only student feedback has been obtained. Therefore, teacher feedback should also be included and its effectiveness should be evaluated further.

CONCLUSION
Edmodo should be explored to improve contact time with the learners, as this generation's learners are not ready to learn the traditional way in the new digital age. The teachers should then teach the way learners want to be taught.