Medical Students' Perceptions and Performance in an Online Regional Anatomy Course during the COVID-19 Pandemic
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| Title: | Medical Students' Perceptions and Performance in an Online Regional Anatomy Course during the COVID-19 Pandemic |
|---|---|
| Language: | English |
| Authors: | Zhang, Ji-Feng (ORCID |
| Source: | Anatomical Sciences Education. Aug-Sep 2022 15(5):928-942. |
| Availability: | Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us |
| Peer Reviewed: | Y |
| Page Count: | 15 |
| Publication Date: | 2022 |
| Document Type: | Journal Articles Reports - Research |
| Education Level: | Higher Education Postsecondary Education |
| Descriptors: | Medical Students, Medical Education, Well Being, Student Experience, Student Attitudes, Anatomy, Distance Education, Electronic Learning, Foreign Countries, Program Effectiveness, Video Technology, Telecommunications, Anxiety, Depression (Psychology), Online Courses, Self Esteem, Academic Achievement |
| Geographic Terms: | China |
| DOI: | 10.1002/ase.2208 |
| ISSN: | 1935-9772 1935-9780 |
| Abstract: | The present study evaluated the students' psychological well-being, experiences, performance, and perception of learning regional anatomy remotely. A regional anatomy remote learning curriculum was designed and learning materials were delivered virtually to 120 undergraduate medical students at Jinan University, China. All the students consented and voluntarily participated in this study by completing self-administered online questionnaires including the Zung's Self-Rating Anxiety and Depression Scales at the beginning and end of the learning session. A subset participated in focus group discussions. Most of the students (90.0%) positively evaluated the current distance learning model. More than 80% were satisfied with the content arrangement and coverage. Many students preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during the distance learning sessions. However, writing laboratory reports and case-based learning were the least preferred modes of learning as they were only preferred by 23.2% and 14.1% of the students, respectively. There was no significant lockdown-related anxiety or depression reported by students using depression and anxiety scales as well as feedback from focus group discussions. The surveyed students' confidence scores in distance learning were significantly higher after 5 weeks than at the beginning of the session (3.05 ± 0.83 vs. 3.70 ± 0.71, P < 0.05). Furthermore, the present results showed no significant differences between the current group's academic performance in the unit tests as well as the final overall evaluation for different parts of the course compared to that of the previous year's cohort. The findings above were congruent with focus group discussion data that the use of the online teaching platform for regional anatomy significantly improved the students' confidence in virtual and self-directed learning and did not negatively affect their academic performance. |
| Abstractor: | As Provided |
| Entry Date: | 2022 |
| Accession Number: | EJ1347294 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwGI70KaT3bpbpyNNWXQ3wMlAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDI40xdOr8MVUmpgFNAIBEICBmnt6h926vWdtnhTJvmt3bvjqvHR65dGvmOW-q3gzk8leOrXqz2qhpPStChi5Mz0UHRD3KTuhIx8Jp0jptYu4ym1scYcw1rjR7Qm6LfZksiDZvtN7BpyKCorhkw-bi66ZRI3oNrys72susakLvsOpdPe9PEYmvAl4elRbFDSkPO8p-5qoknKJMyI64Hbi3_NXkRdJO7m3WsoZj1U= Text: Availability: 1 Value: <anid>AN0158940087;[8z8k]01aug.22;2022Sep08.04:36;v2.2.500</anid> <title id="AN0158940087-1">Medical students' perceptions and performance in an online regional anatomy course during the Covid‐19 pandemic </title> <p>The present study evaluated the students' psychological well‐being, experiences, performance, and perception of learning regional anatomy remotely. A regional anatomy remote learning curriculum was designed and learning materials were delivered virtually to 120 undergraduate medical students at Jinan University, China. All the students consented and voluntarily participated in this study by completing self‐administered online questionnaires including the Zung's Self‐Rating Anxiety and Depression Scales at the beginning and end of the learning session. A subset participated in focus group discussions. Most of the students (90.0%) positively evaluated the current distance learning model. More than 80% were satisfied with the content arrangement and coverage. Many students preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during the distance learning sessions. However, writing laboratory reports and case‐based learning were the least preferred modes of learning as they were only preferred by 23.2% and 14.1% of the students, respectively. There was no significant lockdown‐related anxiety or depression reported by students using depression and anxiety scales as well as feedback from focus group discussions. The surveyed students' confidence scores in distance learning were significantly higher after 5 weeks than at the beginning of the session (3.05 ± 0.83 vs. 3.70 ± 0.71, P &lt; 0.05). Furthermore, the present results showed no significant differences between the current group's academic performance in the unit tests as well as the final overall evaluation for different parts of the course compared to that of the previous year's cohort. The findings above were congruent with focus group discussion data that the use of the online teaching platform for regional anatomy significantly improved the students' confidence in virtual and self‐directed learning and did not negatively affect their academic performance.</p> <p>Keywords: Covid‐19; gross anatomy education; medical education; online learning; regional anatomy; remote teaching model; undergraduate education</p> <hd id="AN0158940087-2">INTRODUCTION</hd> <p>The current Covid‐19 pandemic has reached all countries around the world disrupting university education in most of them (Evans et al., 2020; Li et al., 2020; Mahmud &amp; Ansarie, 2020; Viner et al., 2020). In China, university students were unable to return to on‐campus traditional classroom learning between January and September 2020 (Cheng et al., 2021). Failure to be on campuses resulted in medical education courses such as anatomy being moved from the traditional classroom environment to many forms of online teaching such as posting post‐edited videos online, live online interactions, and virtual learning platforms (Smith &amp; Pawlina, 2021; Yan et al., 2021). The Covid‐19‐induced lockdown severely disrupted the dissection component of anatomy for medical students thereby calling for immediate implementation of alternative methods to deliver the cadaver dissection content (Romero‐Reverón, 2020; Naidoo et al., 2021). Two large surveys carried out among anatomy teachers in China revealed the relatively poor preparation for online learning in response to the unforeseen pandemic (Cheng et al., 2021; Yan et al., 2021). As a result, the reflections on the experiences and evaluation of the effectiveness of the new shift in learning must be carried out so that lessons drawn are used to illuminate future directions in anatomy education.</p> <p>Distance learning has come a long way with humble beginnings in the United States and United Kingdom institutions and spreading to many institutions across the world (Lehoux et al., 2016; Palvia et al., 2018). Further development of internet and communication technology, online teaching overcame the limitations of the distance between the instructor and students and enabled real‐time computer‐mediated person‐to‐person communication (Svirko &amp; Mellanby, 2008; Guarino et al., 2014; Lehoux et al., 2016; Ozer et al., 2017; Santos et al., 2021). Regional anatomy pedagogy for medical students uses cadavers for identifying the interrelationships of body structures, such as muscles, nerves, and blood vessels as well as their relevance to disease (Wang et al., 2010; Zhang et al., 2020). Conducting didactic online teaching without cadaver dissections has been challenging to both the students and teachers (Singal et al., 2021). Several studies from across the world have reported on the different experiences and challenges faced during the transition from traditional to Covid‐19‐induced virtual learning of anatomy (Longhurst et al., 2020; Romero‐Reverón, 2020; Khan et al., 2021; Lemay et al., 2021). Some studies reported smooth transition and successful use of information technologies to foster anatomy learning (Dulohery et al., 2021; Papapanou et al., 2022). On the other hand, some studies focused on difficulties encountered such as inadequate learning from the students' perspective (Nathaniel et al., 2021; Owolabi &amp; Bekele, 2021; Singal et al., 2021; Zalat et al., 2021). For instance, Nepali medical students did not find online classes as effective as the traditional classroom teachings thereby suggesting a reflection on this subject (Nepal et al., 2020). However, there are limited data on the objective outcome measures of conducting anatomy learning entirely virtually. While a few pre‐pandemic studies have reported the benefits of blended or use of information communication tools in anatomy pedagogy (Diaz et al., 2021; Nathaniel et al., 2021), conducting anatomy teaching entirely online had never happened in recent memory (O'Doherty et al., 2018). Also, some anatomy teachers have expressed widespread concern regarding the effectiveness of the pandemic‐induced adaptations to teaching, assessment, and working environment (Dulohery et al., 2021; Totlis et al., 2021).</p> <p>As a complement to university education, online teaching allows the time and space for traditional teaching to expand, helping students to revisit classroom teaching and solve difficult problems (Dhawan, 2020). Before the current Covid‐19 pandemic, online teaching was not the dominant form of anatomy education in medical schools (Khalil et al., 2020; Attardi et al., 2022). Online education using information and communication technologies such as three‐dimensional (3D), virtual reality, online remedial classes, and smartphone applications had gained acceptance among students and faculty as adjuncts to anatomy learning (Stepan et al., 2017; Alharbi et al., 2020; Nyemb, 2020; Zargaran et al., 2020). Evidence from pre‐Covid‐19 studies had already suggested that the blended learning approach which combined classroom learning with the use of online learning was better than conventional didactic teaching in improving gross anatomy outcomes among medical and healthcare studies students (Cook &amp; Dupras, 2004; Pereira et al., 2008; Green &amp; Whitburn, 2016; Khalil et al., 2018; Ngan et al., 2018). The pre‐pandemic studies also showed that blended learning motivated students taking anatomy to do self‐study, helped them in developing higher order cognitive skills and enhanced learning (Ekeland et al., 2010; Ocak &amp; Topal, 2015; Kharb &amp; Samanta, 2016). However, during the ongoing Covid‐19 pandemic, online teaching has become the dominant form of medical professional teaching, especially for pre‐clinical courses like anatomy (Chiodini, 2020; Schneider &amp; Council, 2021; Mahdy &amp; Sayed, 2022).</p> <p>Anatomy learning is cadaver dissection‐based in China, as in many medical schools around the world. Many Chinese universities, including the present one, could not use dissection alongside other forms of instruction due to the strict lockdown (Yan et al., 2021). As a result, studies to evaluate the effectiveness of online anatomy education, including the efficacy of innovations around missing dissection have become very important (Cheng et al., 2021; Totlis et al., 2021; Yan et al., 2021). This is especially so for informing future policy changes in environments where repeated waves of SARS‐cov2 infections have led to multiple or indefinite lockdowns and normalization of online learning (Zhou et al., 2020; Plümper &amp; Neumayer, 2022). Compared to traditional classroom teaching, distance learning lacks intimate interaction between teachers and students, and there is need for teachers to maintain effective communication with students (Pather et al., 2020; Mahdy &amp; Sayed, 2022). When a new crisis arises, normal life is often disrupted and people's daily established habits as well as ways of working face new reconstructions (Cvetković et al., 2020; di Renzo et al., 2020). While several studies have described innovations around teaching anatomy virtually during the ongoing Covid‐19 pandemic (Harmon et al., 2021; Yoo et al., 2021; Attardi et al., 2022), data on the effectiveness or student feedback on such or similar innovations in China are scanty (Cheng et al., 2021).</p> <p>In addition, several studies from across the world reported anxiety, stress, and depression were high during the Covid‐19‐induced lockdowns among medical students in anatomy courses (Chandratre, 2020; Cuschieri &amp; Calleja Agius, 2020; Guse et al., 2021; Werner et al., 2021). The students' physical, emotional, and mental well‐being was negatively affected by social isolation, social distancing regulations, lack of on‐campus community, as well as loss of peer support systems (Chandratre, 2020). A few studies in Chinese universities have also echoed similar findings among medical students (Xiong et al., 2021; Yan et al., 2021; Fu et al., 2021) albeit slightly less severe compared to the general population (Yan et al., 2021). Therefore, is it crucial that faculty and staff take provide mental health support and implement effective strategies to support medical students' well‐being. Therefore, ongoing studies must find out local mental health needs and experiences to inform policy directions on mental health support for students during similar situations.</p> <p>The Covid‐19 pandemic induced a shift from traditional teacher‐centered learning to virtual learning which provides opportunities for student‐centered learning (Coman et al., 2020). Online learning demands effort from the learners since they are away from school and are in a home environment with competing needs and demands. Medical students are expected to be lifelong learners, an attribute that will enable them to seek specialization as well as participate in continued professional development required for licensure in the future (Zhang et al., 2020). Therefore, to adapt to the home environment learning, medical and healthcare students are supposed to enhance their self‐directed learning abilities (Maphalala et al., 2021; Khodaei et al., 2022; Singaram et al., 2022). Drawing upon social cognitive theories, the present study views remote learning in the context of student‐led "self‐directed learning." According to a proponent of theory of adult learning/andragogy, Knowles (1975), self‐directed learning "describes a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes". Awareness of the effects of remote teaching on the students' self‐directed abilities is important for adapting learning to support struggling students as well as encourage the adoption of lifelong learner traits.</p> <p>The present university's traditional regional anatomy teaching is dissection‐based comprising gross anatomy (lectures, 18 hours and cadaver dissection, 78 hours ), histology (54 hours of lectures and 54 hours of practical sessions), and embryology (20 lecture hours). Prosected models are also available for use by the students as well as during spot examinations. A typical one‐hour long didactic lecture is followed by a two‐hour supervised cadaver dissection with emphasis on relations between anatomical structures covered during the lecture as well as their functions and application in the clinic (Zhang et al., 2020). During the Covid‐19 pandemic‐induced lockdown that extended from January 2020 to September 2020 in China (Cheng et al., 2021), the medical students completed a semester of regional anatomy distance learning according to the original course schedule using the University's online teaching platform. This online course used teaching videos to deliver gross anatomy content while screengrabs of dissected specimens and dissection videos were used instead of actual dissection. In addition, the case‐based learning (CBL) component, a supplementary teaching integrating anatomical and surgical knowledge was also conducted virtually by the surgeons as described previously (Zhang et al., 2020). Therefore, this study aimed to assess the medical students' perceptions of own mental health as well as regional anatomy learning and academic performance following this specially designed online learning model during the Covid‐19 pandemic.</p> <hd id="AN0158940087-3">MATERIALS AND METHODS</hd> <p>This study was approved by the Medical Ethics Committee of Jinan University, (Number: JNU202002). Permission was obtained from the consenting study participants for the contents covered in the text.</p> <hd id="AN0158940087-4">Study population</hd> <p>The participants in this study were 120 undergraduate first‐year clinical medical students from the School of Medicine, Jinan University, Guangzhou City, Guangdong Province China. This sample of participants is not different from previous intakes as they are both post‐high school students aged between 18 and 21. Both cohorts underwent the same competitive entrance procedures such as passing entrance examinations, having high scores in relevant subjects at the Chinese National College Entrance Examinations locally called "<emph>Gaokao</emph>". The present and previous cohorts had no prior exposure to online learning as anatomy, along with other preclinical subjects such as biochemistry and physiology, were delivered face‐to‐face pre‐pandemic. Prior didactic learning involved lecture attendance where the anatomy teachers taught gross anatomy followed by cadaver dissections. This was supplemented with case‐based learning conducted in collaboration with surgeons as described previously (Zhang et al., 2020). The current participants only underwent one semester of such pedagogy (August 2019 to December 2020) before learning abruptly went online due to the Covid‐19 pandemic. Image labeling from screen grabs and post‐dissection write‐ups were never done before the presently described regional anatomy learning. The Clinical Medicine (MBBS) degree is a six‐year program designed to train the students in the field of basic medicine. The program is divided into preclinical subjects such as anatomy, physiology, and biochemistry as well as clinical subjects with rotation in clinical disciplines such as medicine, surgery, obstetrics and gynecology, psychiatry pediatrics, preventive, and social medicine after which they go on a one‐year internship at the University's affiliated hospitals.</p> <hd id="AN0158940087-5">Curriculum design</hd> <p>The medical students were fully informed of the need and structure of distance learning process. The distance learning was conducted according to the course design of the Anatomy department (Figure S1) and lasted for a single semester. The present regional anatomy distance learning syllabus consisted of four components:</p> <hd id="AN0158940087-6">Theory</hd> <p>Comprised of one‐hour gross anatomy: a didactic theoretical overview of the location and relations of the anatomical structures in the region of interest being dissected followed by an outline of their clinical significance. In total, theoretical component (18 hours) was delivered by online video conferences using the WeChat™ (Tencent Inc., Shenzhen, China) video conferencing software linked to the University's learning management platform.</p> <p>The video lectures also gave an overview and description of the process of dissection. The anatomical structures to look for and identify were given as a separate list so that students have a thorough understanding and appreciation of the methods, structures, relations, and location relative to each other, as well as their clinical correlations.</p> <hd id="AN0158940087-7">Laboratory teaching</hd> <p>Since the students were unable to access the dissection laboratory to carry out cadaver dissections during the pandemic‐induced lockdown, the laboratory sessions were taught on the online learning platform that included two‐dimensional (2D) images, pre‐recorded videos of human specimen dissection demonstrations, and carefully annotated texts. The students were required to write a laboratory report after each online session. The laboratory report included: screenshots of the videos and labeling of the marked structures appearing on them, a summary of the course, positions, and relations of the dissected structures along with their clinical significance.</p> <hd id="AN0158940087-8">Case‐based learning sessions</hd> <p>After completing each basic regional anatomy session, three to four real‐world clinical scenarios were selected for case‐based learning (CBL) teaching in the form of online video conferencing hosted by the surgeon as described previously (Zhang et al., 2020). This included the recap of the anatomical basis of clinical symptoms, diagnosis, differential diagnosis, choice of surgical approach, and surgical anatomy.</p> <hd id="AN0158940087-9">Assessment</hd> <p>Formative assessment was carried out in form of end of unit short answer quizzes targeting the identification of structure, relations, and clinical relevance while the summative assessment was at the end of the course incorporation questions across the region under study. The present examinations were conducted online unlike previous ones that were done in person. The final examination was the same format as previous tests (multiple choice and short answer questions) of the same region covering both structure‐function, anatomical relations, and clinical applications. To maintain the year‐on‐year consistency of the regional anatomy questions, an expert opinion approach in which senior anatomists analyzed and moderated present questions in relation to those from the previous academic year was utilized. This enabled comparisons of the current students' performance with that of the previous academic years.</p> <hd id="AN0158940087-10">Course delivery</hd> <p>This session was allocated four hours, of which one hour was used for the online video presentation of gross anatomy content, and three hours reserved for independent study whereby students watch anatomy videos provided and write laboratory reports. The University's online teaching platform anonymously records the time students spent using online learning resources and the assigned anatomy teachers also randomly used the WeChat™ platform (Tencent Inc., Shenzhen, China) to keep track of students' learning. After each human specimen dissection online session, three to four clinical cases were presented during one‐hour CBL teaching session hosted by a surgeon. The communication between teachers and students was carried out on the WeChat (Tencent Inc., Shenzhen, China) platform group feature using texting, pictures, and videos to solve the problems encountered by the students in their studies.</p> <hd id="AN0158940087-11">Questionnaire distribution</hd> <p>All online questionnaires and consent forms were created using the QuestionnaireStar online platform (Changsha Ranxing Information Technology Co., Ltd, Wenjuanxing, China), and a shareable link was distributed to each student using the class WeChat groups platform at the end of the first and fifth weeks after the start of the online learning session. The questionnaires were filled out anonymously but included basic information such as sex and class to ensure that students volunteered to participate in the study.</p> <p>The questionnaire consisted of four main sections: (<reflink idref="bib1" id="ref1">1</reflink>) Section A: The focus was on demographic data and how the pandemic affected students' learning, including the presence of anxiety and depression, and confidence in the distance learning model; (<reflink idref="bib2" id="ref2">2</reflink>) Section B: It focused on the assessment of distance learning content, including the perception of the distance learning model and the preference for different content delivered. (<reflink idref="bib3" id="ref3">3</reflink>) Section C: Focused on whether distance learning can guide students' preparation to return to school for actual dissections and whether they think it improved their perceived efficiency in future human specimen dissections; (<reflink idref="bib4" id="ref4">4</reflink>) Section D: Focused on students' ability to learn independently during the distance learning period.</p> <hd id="AN0158940087-12">The psychological well‐being of students</hd> <p>The psychological well‐being of students during the pandemic‐time learning was assessed at 1 week before and at the end of the fifth week of online learning using the Zung Self‐Rating Anxiety Scale (SAS) Anxiety and the Zung Self‐Rating Depression Scale (SDS). The SAS is a 20‐item tool whose scores are rated on a four‐point scale ranging from 20–80. A score of 20–44 falls under normal range, 45–59 is mild to moderate anxiety levels, 60–74 marked to severe anxiety levels while 75–80 denoted extreme anxiety levels (Zung, 1971). The SDS, a 20‐item measure, with each item rated on a four‐point scale. The Zung Self‐Rating Depression Scale scores are classified as normal (&lt;50), mild depression (50 to 59), moderate to marked major depression (60 to 69), and severe to extreme major depression (&gt; 70) (Zung, 1965). The students were asked to rate their anxiety and depression levels via an online link provided through the WeChat platform (Tencent Inc., Shenzhen, China).</p> <p>The students were invited to participate in this study via the class' WeChat™ (Tencent Inc., Shenzhen, China) group and reminders were given every second day for 1 week by the assigned class representative. Breakaway WeChat groups were created on Wechat™ (Tencent Inc., Shenzhen, China) at the end of the week and those willing to participate joined anonymously via a QR code. The purpose of the focus group discussions was explained in the group and study participants' consenting were provided with consent forms they downloaded and re‐submitted.</p> <hd id="AN0158940087-13">Focus group discussion data collection</hd> <p>Guidelines for the discussion points were designed by the first and second author following a review of literature and consulting experts in qualitative research (Breen, 2006; Bush et al., 2019; Atwa et al., 2022). All authors revised and approved the final draft consisting of 10 items covering all dimensions of lived experience while learning anatomy during Covid‐19 lockdowns including mental health status.</p> <p>Each focus group discussion began with introductions and reiteration of the purpose of the study as well as confidentiality guarantees. The participants were then asked about their lived experiences with online anatomy learning, the differences between online and face‐to‐face learning, challenges faced, confidence as well as levels of satisfaction with online content coverage and assessments. The participants were also asked about their mental health and coping strategies during the Covid‐19 period and how that compares with pre‐pandemic and currently. The focus groups lasted between 90 and 120 min. During the last two focus group discussions, the moderators reach agreement that saturation had been achieved and that conducting further discussions would not add any new information.</p> <hd id="AN0158940087-14">Statistical analysis</hd> <p>All data were expressed as mean ± standard deviation along with measures of central tendency and analyzed using SPSS statistical package, version 26.0 (IBM Corp., Armonk, NY) with a <emph>P</emph> &lt; 0.05 considered a statistically significant difference. The Chi‐square test was used to examine differences between categorical variables. Comparisons between groups was by ANOVA or Student's t‐testing as applicable. A <emph>P</emph>‐value &lt;0.05 was considered statistically significant. Face and content validation of the questionnaire was done using the expert opinion approach involving epidemiologists and senior anatomists. The piloting was conducted by asking the anatomy faculty to answer the questionnaire. Cronbach's alpha was used as a measure of the questionnaire's internal consistency/reliability. Cohen's <emph>d</emph> value, determined by calculating the mean difference between two groups, and then dividing the result by the pooled ±SD was used to assess the effect size.</p> <p>The focus group discussions were recorded and transcribed verbatim. The data analysis followed Grounded Theory as spelled out previously (Zilundu et al., 2022). Grounded theory is an inductive, comparative methodology that offers orderly guiding principles used to gather, synthesize, analyze, and conceptualize qualitative data for theory construction that was developed by Glaser and Strauss (1967). A constructivist grounded theory approach was used to explore the learners' use of lived experience during anatomy study. The constructivist grounded theory allows researchers to use their own experiences as well as relevant literature to conduct the interviews (Chun et al., 2019). A constant comparison approach consistent with grounded theory whereby qualitative researchers look for similarities and differences in the data (Gale et al., 2013) was used to analyze focus group discussion data. Those data that were similar were grouped under a keyword or category and each new piece of data was compared to previous data and sorted into the most relevant category. Once all the data were reviewed, the researchers collapsed some categories and pooled patterns or themes from the data. The researchers sat together and read successive focus group discussion responses searching for meanings, recognizable patterns, or ideas in the responses of participants that were relevant to motivation and study strategies used by the students in studying anatomy. Disagreements between researchers were resolved through discussion to reach a consensus as reported previously (Zilundu et al., 2022).</p> <hd id="AN0158940087-15">RESULTS</hd> <p>A total of 120 students (65 males, and 55 females), aged between 19 and 25 (21.0 ± 3.3), voluntarily participated in this study after signing e‐consent forms. These were all post‐high school entrants with no prior exposure to anatomy before beginning medical school. Prior to the current study, all these students were exposed to one semester of cadaver‐based regional anatomy course. They were mainly from 24 provinces and autonomous regions of mainland China, including two students from the Macao Special Administrative Region. Sixty‐nine students were from Guangdong Province while the rest were from the rest of the 23 mainland China provinces. A total of 120 questionnaires were distributed and all were returned completely filled‐in as requested (Tables S1–S3). The Cronbach's alpha was 0.87 suggesting that the present instrument was reliable.</p> <hd id="AN0158940087-16">Evaluation of the teaching model and content organization</hd> <p>Over 90.0% of the students positively evaluated the current distance learning model while less than 10.0% were less satisfied with the remote teaching model (Figure 1A). Slightly more than 80.0% of the students who participated in this study were satisfied with both the course content (4.13 ± 0.67, range −3 to 5 slightly negatively skewed −0.14 and highly platykurtic, −0.78) and coverage of the regional anatomy (3.83 ± 0.55, range 2 to 5 with moderate negative skewness −0.41 and highly leptokurtic 0.83) during the distance learning session compared to a distant minority which perceived that the content and coverage were inadequate (Figure 1B, Table S1). In addition, 48.0% of the students felt that the assignments given during the distance learning period were excessive (3.53 ± 0.67; range 2 to 5 with slightly negative skewness −0.29 as well as kurtosis −0.12) compared to a small majority that felt that these were at least adequate (Figure 1B, Table S1). Student feedback is crucial for curriculum design and evaluations. In the present sample, most of the students preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during the distance learning sessions. Furthermore, other forms of instruction employed during the distance learning model such as dissection report writing (23.2%) and CBL (14.1%) the distance learning sessions were not favored by many students (Figure 1C). There were no statistically significant differences between male and female medical students' perception of the distance learning course, content, and assignments of how the course was presented (Figure S1; <emph>P</emph> &gt; 0.05).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01aug22/ase2208-fig-0001.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2208-fig-0001.jpg" title="1 Students' evaluation of the distance learning process. (A) students' attitudes toward distance learning of regional anatomy; (B) students' evaluation of regional anatomy distance learning content; (C) students' preferences for course content, coverage, and assignments. aDenotes statistically significant difference P &lt; 0.05 on Student's t test between the students who had negative compared to those with a positive evaluation of the distance learning of regional anatomy and its content. Number of participants (n = 120)." /> </p> <p></p> <hd id="AN0158940087-18">Psychological well‐being of students during the pandemic‐time learning</hd> <p>The psychological well‐being of the 120 students who studied at home during the Covid‐19 pandemic was investigated using the Zung Self‐Rating Anxiety Scale (SAS) and Zung Self‐Rating Depression Scale (SDS) (Zung, 1965, 1971). Cronbach's alpha values reflecting internal consistency were 0.87 and 0.89 for the SAS and SDS, respectively. These results demonstrated that, as shown in Figure 2A,B, most of the students did not report any significant anxiety or depression before and during the pandemic‐induced online learning period (<emph>P</emph> = 0.45). A minority reported psychological pressure by way of only mild anxiety, indicating that they were under less pandemic‐induced psychological pressure during the time they were supposed to complete the study tasks. No students reported experiencing moderate to severe or extreme anxiety or depression during the periods under investigation.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01aug22/ase2208-fig-0002.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2208-fig-0002.jpg" title="2 Medical students' anxiety, and depression during home‐based learning (A) medical students' anxiety during the home study using the Zung Self‐Rating Anxiety Scale (SAS); (B) medical students' depression measured with the Zung Self‐Rating Depression Scale (SDS) during the home study; (C) medical students' changes in confidence during home study. Confidence is expressed on the following scale 1 = not confident at all; 2 = not confident; 3 = unclear; 4 = confident; and 5 = very confident. Score of confidence is displayed as means ± SD; adenotes statistically significant difference P &lt; 0.05. Number of participants (n = 120)." /> </p> <p></p> <p>The change in the students' confidence in the current distance learning model was evaluated and showed that only 26.7% of the students were confident in learning regional anatomy remotely before and at the introduction of the distance learning model. However, after 5 weeks of learning, their confidence increased as the majority (65.0%) of the medical students felt confident in achieving the learning objectives using home‐based learning (Table S1). Further analysis showed that students' confidence scores in distance learning after 5 weeks were significantly higher than at the beginning of the Covid‐19 outbreak (3.05 ± 0.83 vs. 3.70 ± 0.71, <emph>P</emph> &lt; 0.05, with a large Cohen's <emph>d</emph> effect size of 0.84; Table S1).</p> <p>The University's online learning system allows for monitoring of the student's activity on the platform once they log in. Since distance learning requires self‐discipline, the medical students' learning scheduling, and the ability to sustain attendance during the remote learning tasks were also assessed. The data derived from the online management system showed that more than 90.0% of the medical students were able to follow the course schedule and pace without teachers' supervision, while 10.0% of them were unable to log in on time and remain active on the platform. All the students were able to submit homework and dissection write‐up reports on time as scheduled. The above results showed that the majority of the medical students were able to quickly adapt and complete the course according to the teaching schedule while a few faced some challenges.</p> <hd id="AN0158940087-20">Perceptions of importance and preparations for post‐return human specimen dissections</hd> <p>Compared to traditional classroom‐based learning, distance instruction during the Covid‐19 pandemic prevented access to dissection laboratories and dissections. Therefore, remote learning sessions lacked the inherent manipulation, identification, and sense of presence associated with actual human specimen dissections. Most of the medical students (95.0%) reported that human specimen dissections were very important in learning regional anatomy (4.67 ± 0.52, range 3 to 5, with a slight negative skewness as well as a moderate positive/leptokurtic kurtosis 0.55) compared to a remainder that felt otherwise (Figure 3A). As shown in Figure 3B, slightly over 90.0% want to return to school as soon as possible to perform such dissections while the remainder does not look forward to resuming dissections.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01aug22/ase2208-fig-0003.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2208-fig-0003.jpg" title="3 The impact of distance learning on human specimen dissections. (A) Students' perception of the importance of dissections; (B) medical students' desire to return to school for dissections; (C) Writing laboratory reports is more effective than theoretical learning alone; (D) the distance learning model can improve the efficiency of human specimen dissections after schools open. aDenotes statistically significant difference P &lt; 0.05. Number of participants (n = 120)." /> </p> <p></p> <p>Although online dissection videos are far from being a perfect substitute for actual human specimen dissections, most of the medical students (90.0%) felt that distance online instruction helped them prepare to perform dissections when they return to school (4.28 ± 0.71, range 1–5 ith a slight negative skewness and a highly positive kurtosis, 2.51) (Table S2). Writing laboratory reports from dissection video screenshots were perceived to be more useful for mastering anatomy content than theoretical virtual teaching alone during the distance learning sessions by a small majority of the students (Figure 3C). More than three‐quarters of the medical students felt that their human specimen dissections would be more efficient after being prepared by distance instruction (Figure 3D). These results indicated that, although human specimen dissections could not be performed via distance learning, theoretical learning and the writing of laboratory reports provided a good foundation for future face‐to‐face learning and dissecting.</p> <hd id="AN0158940087-22">Development of self‐directed learning skills</hd> <p>Online learning requires self‐discipline as well as student‐led planning of learning pace and content acquisition. This helps students to develop and use their self‐directed learning skills. Studying anatomy from home was not associated with a significant change in the way the students used various methods of solving problems encountered during learning. However, by the end of the five‐week course, the number of medical students who reported using search engines to solve course‐related problems had marginally increased by 10.0% (Figure 4A) (2.47 ± 0.84 vs. 3.00 ± 0.78, Table S3; <emph>P</emph> &lt; 0.05). In addition, more than 80.0% of medical students believed that distance teaching was helpful in significantly nurturing their self‐directed learning skills (Figure 4B) while a few of them did not find remote teaching helpful. A marginal rise in self‐directed learning ability was reported from the first to the fifth week (3.69 ± 0.55 vs. 3.87 ± 0.57, Table S3; <emph>P</emph> &lt; 0.05). CBL teaching is a student‐centered teaching method that presents real‐world clinical scenarios that medical students are supposed to solve with their clinical reasoning skills and integration of learned theoretical knowledge. The majority (73.4%) of the medical students believed that they could use the anatomical knowledge material covered during the pandemic‐era distance learning to solve related clinical problems (Figure 4C). The data show that distance online teaching helps to improve medical students' self‐directed learning abilities as well as the application of anatomical knowledge to related clinical correlates.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01aug22/ase2208-fig-0004.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2208-fig-0004.jpg" title="4 The effect of the distance learning model on medical students' self‐directed learning ability. (A) Solutions adopted by medical students when they encounter difficulties; (B) the development of medical students' independent learning skills by the regional anatomy distance learning model; (C) medical students' ability to analyze clinical problems using anatomical knowledge acquired during the distance learning period. aDenotes statistically significant difference P &lt; 0.05. Number of participants (n = 120)." /> </p> <p></p> <hd id="AN0158940087-24">Evaluation of distance teaching effectiveness</hd> <p>To evaluate the effectiveness of the current online teaching model more objectively, the medical students' understanding of basic anatomical knowledge was tested using questions comparable to those given to the previous on‐campus cohort. The results showed that there was no significant difference between the present group's mean academic performance in the unit tests as well as the final overall evaluation for the lower limb unit under the 6 weeks distance session as well as other different parts of the regional anatomy course covered under the remote session compared to corresponding marks of the previous stream (Figure 5).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/8Z8K/01aug22/ase2208-fig-0005.jpg?ephost1=dGJyMMvl7ESepq84yOvsOLCmsE6epq5Srqa4SK6WxWXS" alt="ase2208-fig-0005.jpg" title="5 Analysis of the effect of distance learning on academic performance. Show comparable performance between examinations written during the distance learning period and other traditional teaching time, P &gt; 0.05." /> </p> <p></p> <hd id="AN0158940087-26">Focus group discussion results</hd> <p>A thematic content analysis yielded three core themes namely the positive evaluation of the teaching model and content organization, psychological well‐being of students during the pandemic‐time learning and the development of self‐directed learning skills amid distance teaching.</p> <hd id="AN0158940087-27">Positive evaluation of the teaching model and content organization</hd> <p>Converging themes from the focus group discussions analysis showed that most of the students did not feel that they currently had adequate anatomy knowledge as they were still in the process of studying the subject as well as integrating with other equally challenging subjects. Interestingly, at least five of them agreed that the anatomy content is massive, and they also thought that information decay is going to make them forget much of it by the time they reach final year of medical school as aptly captured by one who said that:</p> <p>'At first, studying at home was difficult because there are many things to do and following the schedule of online lectures as well as assignment such as dissection laboratory reports was difficult. Learning at school to use cadavers was easier and can use the library to study undisturbed'.</p> <p>However, despite the feelings of inadequacy, most of them agreed that the teaching model was well organized, and the content was presented in a manner that allowed them to follow satisfactorily from home. However, the dissection component and report writing emerged as burdensome to many. These findings were congruent with the quantitative data from the questionnaire used in this study.</p> <hd id="AN0158940087-28">Psychological well‐being of students during the pandemic‐time learning</hd> <p>Most students reported that while they were anxious about getting back to campus to resume studies, most of their feelings did not amount to pathological levels as they were safe in their homes with family. The lockdown was only short‐lived as it covered one semester only. Chief among the concerns in the beginning of the pandemic‐induced lockdowns were worries that they might fail to complete their degrees on time. Most students reported linking up with classmates via WeChat to keep company and share learning materials as well as study tips. One student captured her psychological well‐being as follows:</p> <p>'... of course I am going to forget a lot of anatomy knowledge, being at home (during the Covid‐19 pandemic) with all the uncertainty of whether schools will open or not or waking up to follow the schedules of lectures from home was stressful, but I do not think that it was too much to cause anxiety or depression because I was in the company of family and could chat with my friends on the Internet'</p> <hd id="AN0158940087-29">Development of self‐directed learning skills amid distance teaching</hd> <p>Many of the medical students felt that during the first days, maintaining the learning schedule and study timing was very difficult from home. This included keeping up with the various subjects in one day (Biochemistry, Anatomy, and Physiology). They recognized that the teachers were not always available and most of the learning was shifted to them. They had concerns about how the examinations would be conducted and if they would have enough information to pass these tests. In response to the shift to remote learning, many students reported re‐learning how to create study timetables, set up alarms to follow it as well as practice learning anatomy using siblings and classmates via WeChat. As time went by, they began to gain control over their schedules, study time, and devised self‐assessment methods to monitor their anatomy learning.</p> <hd id="AN0158940087-30">DISCUSSION</hd> <p>The Covid‐19 pandemic has disrupted dissection‐based regional anatomy teaching. The present evaluation of an online distance learning model for regional anatomy teaching that uses an online learning platform revealed that the majority of the medical students well received it. Most of the students also perceived that the content, pace, and content delivery were adequate. However, there were some students that felt the workload was excessive and could not follow the schedule of the distance learning model. Such findings provide a rationale for adapting anatomy education based on feedback from students in learner‐centered higher education contexts.</p> <p>Emerging data suggest that the general population could be susceptible to the pandemic‐related stress and related anxiety (Bartoszek et al., 2020). Generally, higher education sector students were worried about examination and whether they will complete their education during the Covid‐19 pandemic with a minority exhibiting symptoms of anxiety (Cuschieri &amp; Calleja Agius, 2020; Fu et al., 2021; Tahara et al., 2021; Werner et al., 2021). The present study showed that medical students did not report experiencing severe psychological problems directly attributed to Covid‐19 lockdown during the half‐year‐long home study period. This was supported by the absence of moderate–severe‐critical anxiety and depression ratings on the Zung Self‐Rating Anxiety and the Depression scales as well as feedback given during post‐lockdown supplementary focus group discussion sessions. These findings suggested that the medical students were not under significant mental health strain in their lives in the face of the Covid‐19 pandemic. While the scales maybe not be very sensitive, these findings are concordant with a nationwide study performed on college students in China whereby the prevalence of depression or anxiety was very low (Wang et al., 2020; Xiao et al., 2020; Fu et al., 2021). The local student population was largely at home, access to Internet to interact with peers and being preclinical students, were not exposed to the virus as the lockdown in China was very strict. In contrast, while anxiety levels were low, the incidence of depression among attending healthcare workers was high due to difficult working conditions (Zhang et al., 2021). Therefore, the students in the present sample may have easily adapted and then adequately prepared to carry out online learning from their homes. Going forward, it would be crucial that educators check in with students often as well as identify and support struggling students (Gewin, 2020). It is also important to provide students with company, answers to curriculum uncertainties and in cases loss of loved ones or significant others that died because of Covid‐19 complications.</p> <p>Since medical students had never received completely online teaching before (Kellogg, 2011; Abd‐Elsayed &amp; Lawrence, 2013; Dost et al., 2020), they are generally skeptical about the usefulness of online learning, especially for courses like anatomy that require cadaver dissection. Low confidence in the ability to meet curriculum objectives was a characteristic of the present sample at the beginning of the online sessions and similar sentiments were echoed during focus group discussions. However, after some time attending online classes, the medical students started to accept the online teaching model and, thus showed a marginal increase in the degree of confidence that it would meet their curriculum objectives. These findings are concordant with reported from other settings outside China (Dost et al., 2020; Martini et al., 2021; Totlis et al., 2021). Medical students' skepticism toward distance learning is mainly due to the indoctrination style of didactic teacher‐led education they experienced from primary school to university (Gao et al., 1999; Lam et al., 2006). Although some universities have carried out different forms of teaching reforms such as the flipped classroom and blended teaching, the traditional teacher‐led classroom teaching still makes the medical students dependent on the university teacher (Luo et al., 2013; Jiang et al., 2016; Zhao et al., 2016). The reason for showing confidence in home‐based learning mainly stems from the fact that teachers are readily available via WeChat (Tencent Inc, Shenzhen China), a local messaging application that also has groups and classroom features. The specific disinhibition away from university office hours to "learning virtually" that included evening schedules could have increased interaction online along with increased confidence also. Therefore, medical students could raise the questions they face during learning at any time while teachers could answer the students' problems at any time, a feature generally restricted to office hours during the normal learning times (face to face). Also, medical students reported that in this synchronous teaching model they felt that teachers are always around, which could have prevented the discomfort brought about by the drastic change in teaching methods. The present findings were in agreement with other students in mostly synchronous settings that reported greater support of their basic psychological needs as well as a greater overall satisfaction with the online term compared to students in mostly asynchronous settings (Khalil et al., 2020; Fabriz et al., 2021).</p> <p>Awareness of whether the students have confidence in an online distance learning model or not is the most central and crucial aspect of course design as well as accomplishing the course objectives (Xiao et al., 2007; Bączek et al., 2021). The present study showed that, although medical students still preferred the traditional classroom, a large majority of them were satisfied with the course content and were positive of the online distance teaching model for regional anatomy. This is in agreement with several studies that have evaluated the same (Nepal et al., 2020; Bączek et al., 2021; Singal et al., 2021; Potu et al., 2022). A recent study carried out among medical students showed that medical students in China were already exposed to numerous online learning modes and this prior exposure was positively associated with students' evaluation of and satisfaction with current online education (Wang et al., 2020). While several other studies from across the world also noted the positive reviews of online learning (Gismalla et al., 2021; Tempski et al., 2021), some, on the other hand, noted Covid‐19's overall‐negative impact on their learning, course satisfaction, and sense of community (Mukhtar et al., 2020; Nepal et al., 2020; McWatt, 2021; Wilhelm et al., 2022). The reported positive feedback in the present study could have arisen from how the teaching model was designed. For example, in the present synchronous online teaching model, the teachers took a step‐by‐step approach, cascaded anatomical information from simple to complex, and provided clear knowledge points according to the change in the teaching format. The present study's thrust is concordant with the recommendations by Mukhtar et al., (2020) on training teaching and support staff on the use of online modalities and lesson plan development that minimizes cognitive overload while promoting increased interaction. This also is in line with the strategies for facilitating a student‐centered environment online set out by McWatt (2021). Furthermore, in the absence of a choice, it is possible that the students could simply be grateful of how the anatomy teachers have attempted to making sure the learning programs continue despite the lockdown.</p> <p>Since access to the laboratory for human specimen dissections was not possible during the ongoing pandemic, most of the medical students reported eagerness to return to the laboratory to perform hands‐on isolation and identification of anatomical structures on real specimens. During focus group discussions, the majority of the students indicated that they will likely forget anatomy knowledge despite its importance in clinical practice. Also, most of the medical students felt that despite the solid knowledge gained through distance learning it would be crucial to complete cadaver dissections when they return. These findings were concordant with several other studies from across the world (Kim et al., 2021; Onigbinde et al., 2021; Papapanou et al., 2022). Although the dissection process was only via video demonstrations, the students reported gaining an understanding of anatomy content as well as abilities to carry out future dissections and to confidently locate structures quickly. Writing the laboratory report was good for deepening their understanding of anatomy since they were able to correctly identify the location and relations of anatomical structures by taking screenshots and labeling structures in view, a method successfully used by others (Kim et al., 2021). However, data from focus group discussions revealed that most felt it increased the workload likely predisposing them to stress since anatomy was not the only subject being learned during the lockdown period. It is, therefore, crucial that as teachers seek to carve a niche for their subject, they must be aware of the demands of other subjects. On a good note, the medical students' enthusiasm for writing laboratory reports increased after they became aware that they would still have access to the dissections once the pandemic permits the resumption of on‐campus learning. Furthermore, this could have driven the positive evaluation of the online model because the students could be thinking of it as adaptations taken during desperate circumstances.</p> <p>The online teaching model became a blended learning type where online learning was supplemented with cadaver dissections after September 2020 when the lockdown was lifted and in‐person tertiary education resumed in China (Cheng et al., 2021). In addition, three‐quarters of medical students felt that they would undoubtedly carry out the human specimen dissections quickly since they had gained a good understanding of spatial relations of the human bodily structures from the online learning sessions. The students also felt that if the sense of being present in the dissection room was set aside, the distance instruction was still no less effective than a traditional classroom for gaining anatomical knowledge. These findings were discordant with some studies (Nepal et al., 2020; Bączek et al., 2021; Totlis et al., 2021; Wilhelm et al., 2022). However, similar studies and expert opinions have suggested that online learning of anatomy could be as equally effective as face‐to‐face learning (Zhou et al., 2020; McKivigan et al., 2021; Zheng et al., 2021; Mishall et al., 2022). This suggests that the strong theoretical grounding accumulated through distance teaching during the pandemic‐induced lockdown era was beneficial for scheduled dissection work after returning to school. Such success could be useful in the implementation of blended learning models as has been suggested previously (Ngan et al., 2018; Chen et al., 2020; Yoo et al., 2021). Caution should be exercised, however, since blended learning has been perceived to increase the workload for students (Green &amp; Whitburn, 2016; Pather et al., 2020).</p> <p>Online teaching during the pandemic replaced traditional teaching and possibly discarded the original cram‐type teaching method (Chen et al., 2020; Yang et al., 2020). In the present study, medical students generally believed that the distance teaching model improved their self‐directed learning abilities. During the first week of online learning, some of the medical students sought help from the anatomy teachers through the WeChat mobile phone application when they encountered problems. However, as they became familiar with the new teaching model, most of them became independent of the teachers and relied on the online teaching platform to seek help from Baidu (Baidu, Inc. Beijing, China) and Google search engines (Google LLC, California, USA) for difficult questions. They also initiated and sought interactive discussions with their classmates. As a result of continued distance learning, medical students began to find solutions to anatomical problems on their own rather than relying solely on the teachers. This shows the positive effect of the pandemic on the development of independent learning skills. The student's ability to direct their conceptualization, design, conduct, and evaluation of learning such as being required to follow the schedule of the online sessions is the desired trait (Tekkol &amp; Demirel, 2018). In agreement with a Greek study, remote learning cannot replace the traditional anatomy teaching method (Totlis et al., 2021).</p> <p>In the case‐based learning teaching sessions led by the surgeons, medical students discussed the clinical cases as a group, relying on each other to analyze the anatomical reasons for the occurrence of clinical manifestations, make recommendations for surgery, and independently complete their thinking about clinical problems. Through one semester of online teaching, the formative quizzes, as well as the summative evaluation results also reflected that performance during online distance learning was not significantly different from the traditional classroom era (Zhang et al., 2020). While teachers facilitate learning, it is likely that the students also adapted to the "new normal" and were able to self‐direct their learning through taking charge of planning, continuing, and evaluating their learning experiences leading to favorable outcomes (Tekkol &amp; Demirel, 2018).</p> <hd id="AN0158940087-31">Limitation of the study</hd> <p>There are some limitations of this study: the study habits of this sample of Chinese medical students may not be representative of other regions and countries due to cultural differences and learning habits. As a result, the generalizability of the findings of this study has geographical limitations and only reflects the characteristics of Chinese medical students' learning during this time. Due to the abruptness of the Covid‐19 pandemic and the lag in the construction of online distance learning infrastructure and resources, the integration of 3D and virtual dissection resources needs to be sped up to improve the simulation experience of online teaching (Izard et al., 2017; Erolin et al., 2019). Human specimen dissections were only carried out after the end of the pandemic‐induced lockdown to supplement online teaching. These went well, students were able to follow through dissections quickly and went on to cover the rest of the anatomy syllabus using face‐to‐face learning. Reflections through focus group discussions showed that online learning was worthwhile, although it increased the workload for both teachers and students. Future studies and innovations should, at least, include a blending of both online learning and face‐to‐face methods to maximize the benefits instead of pushing out cadaver dissections on the strength of some positive studies (Evans &amp; Pawlina, 2021). Some countries are still under lockdowns or medical schools have gone into repeated disruptions; thus, the experiences of the present studies could give them pointers on how to adapt their remote teaching, especially on using alternatives to dissection and mental health support.</p> <p>An independently designed model of theoretical teaching, cadaver dissection teaching, and evaluation designed to solve the problem of disrupted normal anatomy teaching activities during the Covid‐19 pandemic have been described. It provides a narrative of experience acquired during the distance teaching of regional anatomy that may be applicable in other universities and related disciplines around the world. However, because it is an emergency response to a crisis, many problems were encountered in the implementation process: The online teaching under this model was limited to the outbreak period and was not directed at the complete teaching process. Also, the results of this investigation do not cover the entire anatomy curriculum. Also, the concept of self‐directed learning has not been fully explored (Li &amp; Wang, 2013). Distance teaching during the pandemics requires good self‐discipline and learning initiative. Since the special teaching response measures described herein were taken during the ongoing pandemic, the evaluation of its long‐term effects could not be studied by mixed group comparison and has only been judged based on the students' subjective feelings and periodic assessments.</p> <hd id="AN0158940087-32">CONCLUSIONS</hd> <p>Online distance learning is necessary as a form of normal teaching during the Covid‐19 pandemic. The online teaching platform for regional anatomy ensures effective teaching activities, helps medical students to build confidence and self‐directed learning abilities to cope with the crisis at hand, and also ensures that the same quality of teaching, as well as meeting curriculum requirements, can be achieved.</p> <hd id="AN0158940087-33">ACKNOWLEDGMENTS</hd> <p>The authors thank all the students who participated in this study. This work was supported by the National Steering Committee for Postgraduate Education of Medical Degrees, Research Project of Working Committee of Medical Degree of Chinese Academic Degrees and Graduate Education Society (A2‐YX20190302‐01), Graduate Education Innovation Program of Guangdong Province (2019JGXM22). The Guangdong Undergraduate University Teaching Quality and Teaching Reform Project (Grant number 2018‐1). The funding body had no role in the design of the study and collection, analysis, and interpretation of data, and in writing the manuscript.</p> <hd id="AN0158940087-34">FUNDING INFORMATION</hd> <p>National Steering Committee for Postgraduate Education of Medical Degrees, Research Project of Working Committee of Medical Degree of Chinese Academic Degrees and Graduate Education Society, Grant/Award Number: A2‐YX20190302‐01; Graduate Education Innovation Program of Guangdong Province, Grant/Award Number: 2019JGXM22; The Guangdong Undergraduate University Teaching Quality and Teaching Reform Project, Grant/Award Number: 2018‐1.</p> <p>GRAPH: FIGURE S1</p> <p>GRAPH: TABLE S1</p> <ref id="AN0158940087-35"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Prof Ji‐Feng Zhang and Dr. Prince Last Mudenda Zilundu have equal contribution to this work and should be considered as first authors.</bibtext> </blist> </ref> <ref id="AN0158940087-36"> <title> REFERENCES </title> <blist> <bibtext> Abd‐Elsayed A, Lawrence JP. 2013. 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She teaches systemic, regional, and applied anatomy to medical students, residents, fellows, and clinicians. Her research interest is in medical education and neurosciences.</p> <p>Prince Last Mudenda Zilundu, B.Sc. (Intercalated), B.Sc., M.Sc., PhD. is an assistant professor in the Department of Basic and Medical Sciences. College of Dentistry at Ajman University, Ajman Emirate, United Arab Emirates. He teaches systemic, regional, and applied anatomy as well as integrated biological sciences to dentistry students. His research interests are in medical education, neurorehabilitation, and neurosciences.</p> <p>Rao Fu, M.D., Ph.D., is an associate professor of anatomy in the Department of Anatomy at Sun Yat‐sen School of Medicine, Sun Yat‐sen University, Shenzhen, China. He teaches clinical anatomy to medical students, residents, fellows, and clinicians. His research interest is in medical education, mental health, and substance abuse neurosciences</p> <p>Xue‐Feng Zheng, M.D., is a lecturer of anatomy in the Department of Anatomy at the School of Basic Medicine, Jinan University, Guangzhou, China. He teaches systemic, regional, and applied anatomy to medical students, residents, fellows, and clinicians. His research interest is in medical education and neurosciences</p> <p>Li‐Hua Zhou, M.D., Ph.D., is a professor of anatomy in the Department of Anatomy at Zhongshan School of Medicine, Sun Yat‐sen University, Guangzhou, China. She teaches clinical anatomy to medical students, residents, fellows, and clinicians. Her research interest is in medical education and neurosciences.</p> <p>Guo‐Qing Guo, M.D., Ph.D., is a professor of anatomy in the Department of Anatomy at the School of Basic Medicine, Jinan University, Guangzhou, China. He teaches systemic, regional, and applied anatomy to medical students, residents, fellows, and clinicians. His research interest is in medical education and neurosciences.</p> </aug> |
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| Items | – Name: Title Label: Title Group: Ti Data: Medical Students' Perceptions and Performance in an Online Regional Anatomy Course during the COVID-19 Pandemic – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Zhang%2C+Ji-Feng%22">Zhang, Ji-Feng</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-7804-7437">0000-0002-7804-7437</externalLink>)<br /><searchLink fieldCode="AR" term="%22Zilundu%2C+Prince+Last+Mudenda%22">Zilundu, Prince Last Mudenda</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-8843-8853">0000-0002-8843-8853</externalLink>)<br /><searchLink fieldCode="AR" term="%22Fu%2C+Rao%22">Fu, Rao</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-7551-4618">0000-0002-7551-4618</externalLink>)<br /><searchLink fieldCode="AR" term="%22Zheng%2C+Xue-Feng%22">Zheng, Xue-Feng</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-3800-8628">0000-0002-3800-8628</externalLink>)<br /><searchLink fieldCode="AR" term="%22Zhou%2C+Li-Hua%22">Zhou, Li-Hua</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2516-2463">0000-0003-2516-2463</externalLink>)<br /><searchLink fieldCode="AR" term="%22Guo%2C+Guo-Qing%22">Guo, Guo-Qing</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1640-343X">0000-0003-1640-343X</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Anatomical+Sciences+Education%22"><i>Anatomical Sciences Education</i></searchLink>. Aug-Sep 2022 15(5):928-942. – Name: Avail Label: Availability Group: Avail Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 15 – Name: DatePubCY Label: Publication Date Group: Date Data: 2022 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Audience Label: Education Level Group: Audnce Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink> – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Medical+Students%22">Medical Students</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Education%22">Medical Education</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Experience%22">Student Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Anatomy%22">Anatomy</searchLink><br /><searchLink fieldCode="DE" term="%22Distance+Education%22">Distance Education</searchLink><br /><searchLink fieldCode="DE" term="%22Electronic+Learning%22">Electronic Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Video+Technology%22">Video Technology</searchLink><br /><searchLink fieldCode="DE" term="%22Telecommunications%22">Telecommunications</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Online+Courses%22">Online Courses</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Esteem%22">Self Esteem</searchLink><br /><searchLink fieldCode="DE" term="%22Academic+Achievement%22">Academic Achievement</searchLink> – Name: Subject Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22China%22">China</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1002/ase.2208 – Name: ISSN Label: ISSN Group: ISSN Data: 1935-9772<br />1935-9780 – Name: Abstract Label: Abstract Group: Ab Data: The present study evaluated the students' psychological well-being, experiences, performance, and perception of learning regional anatomy remotely. A regional anatomy remote learning curriculum was designed and learning materials were delivered virtually to 120 undergraduate medical students at Jinan University, China. All the students consented and voluntarily participated in this study by completing self-administered online questionnaires including the Zung's Self-Rating Anxiety and Depression Scales at the beginning and end of the learning session. A subset participated in focus group discussions. Most of the students (90.0%) positively evaluated the current distance learning model. More than 80% were satisfied with the content arrangement and coverage. Many students preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during the distance learning sessions. However, writing laboratory reports and case-based learning were the least preferred modes of learning as they were only preferred by 23.2% and 14.1% of the students, respectively. There was no significant lockdown-related anxiety or depression reported by students using depression and anxiety scales as well as feedback from focus group discussions. The surveyed students' confidence scores in distance learning were significantly higher after 5 weeks than at the beginning of the session (3.05 ± 0.83 vs. 3.70 ± 0.71, P < 0.05). Furthermore, the present results showed no significant differences between the current group's academic performance in the unit tests as well as the final overall evaluation for different parts of the course compared to that of the previous year's cohort. The findings above were congruent with focus group discussion data that the use of the online teaching platform for regional anatomy significantly improved the students' confidence in virtual and self-directed learning and did not negatively affect their academic performance. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2022 – Name: AN Label: Accession Number Group: ID Data: EJ1347294 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1002/ase.2208 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 15 StartPage: 928 Subjects: – SubjectFull: Medical Students Type: general – SubjectFull: Medical Education Type: general – SubjectFull: Well Being Type: general – SubjectFull: Student Experience Type: general – SubjectFull: Student Attitudes Type: general – SubjectFull: Anatomy Type: general – SubjectFull: Distance Education Type: general – SubjectFull: Electronic Learning Type: general – SubjectFull: Foreign Countries Type: general – SubjectFull: Program Effectiveness Type: general – SubjectFull: Video Technology Type: general – SubjectFull: Telecommunications Type: general – SubjectFull: Anxiety Type: general – SubjectFull: Depression (Psychology) Type: general – SubjectFull: Online Courses Type: general – SubjectFull: Self Esteem Type: general – SubjectFull: Academic Achievement Type: general – SubjectFull: China Type: general Titles: – TitleFull: Medical Students' Perceptions and Performance in an Online Regional Anatomy Course during the COVID-19 Pandemic Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Zhang, Ji-Feng – PersonEntity: Name: NameFull: Zilundu, Prince Last Mudenda – PersonEntity: Name: NameFull: Fu, Rao – PersonEntity: Name: NameFull: Zheng, Xue-Feng – PersonEntity: Name: NameFull: Zhou, Li-Hua – PersonEntity: Name: NameFull: Guo, Guo-Qing IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 1935-9772 – Type: issn-electronic Value: 1935-9780 Numbering: – Type: volume Value: 15 – Type: issue Value: 5 Titles: – TitleFull: Anatomical Sciences Education Type: main |
| ResultId | 1 |
