After Coronavirus pandemic, different pedagogical approaches in e-education have been utilized by many teachers and students all around the world. Therefore, the number of multimedia courseware developed to assist teaching and learning activities has increased tremendously, following the declaration of schools’ closure during COVID-19 pandemic. Reportedly, although teachers and university lecturers had more difficulty adjusting to the new circumstances than university and school student at the beginning, teachers gradually started to develop their digital skills by going beyond using Internet just for searching. They started to design, format, make, and edit their own e-contents through various platforms they had not previously experienced. Students, equally, had to raise their digital literacy skills in order to locate and use various e-resources presented to them. However, this technological growth happened overnight for teachers and students alike, something which contradicts ‘10,000 hours to master a skill’ rule of thumb many suggest. On the other hand, culturally and mentally, there had usually been a disinclination towards e-learning on behalf of many teachers including for example professors teaching at Shiraz University of Medical Sciences (SUMS). Reportedly, although Shiraz Virtual School of Medical Sciences had been established 10 years prior to COVID-19 incidence, a few medical schools and faculty members at SUMS were actively involved in virtual medical education. After teachers were asked to shift from face-to-face education to the virtual mode, we thought it paramount to study SUMS students' viewpoints of e-learning-based medical education that their professors provided during the time Coronavirus pandemic hit Iran.
E-learning
Prior to Coronavirus crisis, e-learning had maintained its prominent position at educational settings, especially for medical education. As Howlett et al. (2009) define, e-learning is the usage of electronic technology for delivering, supporting, and enhancing both learning and teaching; however, it also involves an active communication between a teacher and students(1). In case of medical universities, presenting students with clinical cases, images, videos, and synchronous and asynchronous course activities blended with face-to-face lectures in classrooms has long been established all over the world with various degrees. University infrastructure, teachers’ technical skills and digital literacies beside their teaching load, therefore, their tendency and inclination to digital environments, and institutional support, and attitudes towards e-learning are but few reasons behind the success or failure of e-learning implementation at various medical universities (2–5). Likewise, students, at medical schools or else, have experienced variously based on their background, schools they attend, their digital literacy, e-learning resources as well as institutional support they receive during and after school among many others.
Sometimes the positive or negative attitudes students have towards e-learning are universal. For example, it is widely believed that the negative attitudes of university lecturers towards technology-based education can indirectly cause technology-based education resistance among students which, in turn, lead to a series of challenges for the students (6). Sometimes it is not the e-contents, per se, that produce challenges for students, but failure of teacher-student and student- peer communication that negatively influences students’ productivity in e-learning (7). As Chapman and Mahlk (2004) point out, latest educational technology does not necessarily enhance instruction or students’ participation (8). Also Daniels et al. (2019) indicate that the way e-learning materials are presented to students has a significant effect on the effectiveness of the lesson being taught (9). Sometimes lack of time management and absence of self-regulation are reported as major factors affecting students’ e-learning experience (10). According to Pedrotti and Nistor (2019), not informing students as to when to access the contents means leaving it up to the students who, especially in fully presented on-line courses and due to time constraint and lack of effort regulation strategies, fail to strategically plan their e-learning activities during the course (11).
Pedagogically concerned, heightened cognitive load, as a result of teachers’ ineffective teaching methods, is another challenge repeatedly reported by students (12). Cognitive load theory (CLT) offers a general framework of learning and its association with working memory as well as long-term memory within an e-learning environment (13). Extraneous or ineffective cognitive load presents students with unnecessary information that inhibit their ability to process new information and to create long-term memories (14). As Uppal (2017) indicates, e-learning works only if teachers know how their students learn (15).
Apart from human factors, another challenge that impedes e-learning is technological facilities. Not only at schools and universities, but also at home settings, many students are deprived of access to foundational technology services, software, and hardware to fully explore opportunities that computer-based teaching provides to them (16). Although it is assumed that in the 21st century we might or should not face such challenges anymore, in most developing countries, bandwidth and connectivity issues still cause a perennial hurdle for synchronous and asynchronous e-learning/teaching (17). Even cost of buying Internet packages might be a major concern for many students studying in such countries (16). This has even aggravated undoubtedly during current Coronavirus pandemic that almost all courses are presented online. In terms of Infrastructure, for example, in one study conducted by Koh et al., majority of Malaysian medical students possessed smart devices with medical apps and had reportedly positive feelings regarding the effectiveness of those apps(18). Notably, Wi-Fi and 3G internet services were provided to all them in both university and hospital settings. However, in another study, Masika et al., reported that sub-optimal internet coverage cost of apps, lack of access to smart devices, and limited device memory were the major challenges of using mobile devices and apps for medical education in Kenya(19).
Globally reported, many students have had to receive their course contents in a virtual mode due to their schools’ closure during the pandemic (20). This rapid adjustment to the current global phenomenon has necessitated not only teachers but also students to adapt themselves to this new trend of homeschooling system; in other words, they have been pushed to learn new digital skills and new learning and teaching strategies in a short run. As a result, any observations about the way the coronavirus pandemic is affecting e-learning should be the concern for many researchers at this stage. While online learning might be available during Coronavirus pandemic, it is unlikely to be as effective as face-to-face teaching; those with less resources will disproportionately be disadvantaged due to many reasons including lack of preparation to attend online classes, technical issues and concerns, weak/interrupted internet signals during live lectures, lack of face-to-face interaction, lack of time management, and many more. Even before Coronavirus pandemic, little literature was available on the effectiveness of asynchronous and synchronous e-learning in medical universities and previous studies show that perceived e- learning challenges have to do more to improve technological facilities and the kind of Learning Management System (LMS) which is used in a particular school (21). Therefore, this study could be a significant contribution to knowledge in this area if we mean to understand the perceptions of students regarding to e-learning-attributable inhibiting factors. Furthermore, e-learning is a relatively new innovation in the design of educational facilities at medical universities in Iran, especially during Coronavirus pandemic during which the fast pace of transition from face-to-face classes to distance education mode could not fully prepare the officials and university authorities to evolve their digital tools to ensure uninterrupted educational delivery to every one of the students. Mainly, this study aimed to identify SUMS medical students' views of e-learning-based medical education during Coronavirus pandemic; and To see if there are any differences regarding the students’ general views and their age, gender, residence, digital and computer literacy, type of digital device used, their prior e-learning experience, and degree of study.