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 Table of Contents  
Year : 2023  |  Volume : 15  |  Issue : 1  |  Page : 34-41

Perspectives of Medical Students on E-Learning in the Surgery Module

1 Department of Surgery, College of Medicine, University of Ha'il, Sakaka, KSA
2 Department of ENT, College of Medicine, University of Ha'il, Sakaka, KSA
3 Department of Pharmacology, College of Medicine, University of Ha'il, Sakaka, KSA
4 Department of Surgery, Orthopedic Division, College of Medicine, Jouf University, Sakaka, KSA
5 Department of Intensive Care, Rafha Central Hospital, Northern Region, KSA
6 Department of Surgery, College of Medicine, University of Ha'il, Sakaka, KSA; Department of Surgery, Faculty of Medicine, Alzaeim Alazhari University, Khartoum, Sudan

Date of Submission08-Oct-2022
Date of Decision24-Nov-2022
Date of Acceptance19-Jan-2023
Date of Web Publication31-Mar-2023

Correspondence Address:
Saadeldin Ahmed Idris
Department of Surgery, College of Medicine, University of Ha'il, MPC6+MJ8, Hail 55473; Department of Surgery, Faculty of Medicine, Alzaeim Alazhari University, Khartoum

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajprhc.ajprhc_87_22

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Objectives: The goal of this study was to explore medical students' perceptions, assess their experiences, and identify obstacles to e-learning during the COVID-19 pandemic, as well as to understand the factors behind its adoption and application as a learning means in the surgery module. Materials and Methods: Data were gathered from undergraduate medical students, at the University of Hail, KSA, in their surgery module using an electronic questionnaire. Subsequently, SPSS version 25.0 (IBM, Armonk, NY, USA) has been used for analysis. Results: The study included 72 students, with a participation rate of 85.7%. Students positively perceived technology (M = 4.024 ± 0.94 and P < 0.001). Most respondents (79.5%) claimed that e-learning required less time for studying than the conventional learning technique (M = 4.14 ± 1.052 and P < 0.001). They had positive perceptions of the implications of e-learning (M = 3.92 ± 0.89 and P < 0.001). Regarding the perception toward instructors, 53.9% admitted that when instructors use computer technologies, it adequately met their needs. The mean agreeability to online quizzes was high (M = 3.8264 ± 0.910). More than half preferred the blended style of learning. A-70.9% interested in using e-learning (M = 3.83 ± 1.278 and P < 0.001). There was no statistical difference among genders (P > 0.05). Conclusion: This study addresses the determinants behind the adoption and use of e-learning within the surgery module. Therefore, it will support the event of a rational approach to an effective application of e-learning and look at it as a positive initiative toward development and alteration.

Keywords: Distance learning, e-learning, medical students, online quizzes, perception

How to cite this article:
Fathuldeen AA, Alshammari AO, Khalifah EM, Alrashid FF, Alqahtani AS, Alenazi FS, Alruwaili SH, Alshmmri MA, Idris SA. Perspectives of Medical Students on E-Learning in the Surgery Module. Asian J Pharm Res Health Care 2023;15:34-41

How to cite this URL:
Fathuldeen AA, Alshammari AO, Khalifah EM, Alrashid FF, Alqahtani AS, Alenazi FS, Alruwaili SH, Alshmmri MA, Idris SA. Perspectives of Medical Students on E-Learning in the Surgery Module. Asian J Pharm Res Health Care [serial online] 2023 [cited 2023 Jun 8];15:34-41. Available from: http://www.ajprhc.com/text.asp?2023/15/1/34/373377

  Introduction Top

The surgery possesses a long history of learning. It is customary for all surgical apprentices to use a close follow-up with teachers to gain theoretical knowledge and clinical aptitudes.[1] Conveyance of the learning matter through lectures relies on the existence of the learner and teacher at the same time and place for one-time content delivery.[2] The circumstances of COVID-19 are widespread, driving government authorities in most nations counting Saudi Arabia to force limitations in form of lockdowns and social distancing to assist with concerns almost the protection of both students and staff members. This has influenced surgical education.[1],[3],[4],[5] To preserve secure surgical education, the conventional methods had to unpredictably move to distance learning.[1] In e-learning, students are able to access the materials in any place with Internet access at a time suitable for the student. As well, the same tenor can be conveyed frequently for strengthening and review.[2] The use of e-learning in American colleges dates back to before the end of the past century.[6],[7],[8],[9] The crisis would be an incentive for institutions that had been resistant to adapting the new tools to do so. Skilled education, especially medical education, was exciting during this challenging time.[10] Hence, many years later, e-learning brings the idea that distance education for surgery is almost as real.[11]

The preclinical course of medical education needs less direct clinical contact and was, therefore, possibly it is facile to shift to distance education. Preclinical undergraduates, moreover, need to gain clinical physical examination skills and to make ready for clerkship, and many medical colleges have successfully used prerecorded videos and online interview workshops to develop these skills. Students' responses to online learning are diverse. In a study of 104 undergraduates, 64.1% estimated improved flexibility of distance learning, and so far 56.7% claimed that they were not ready for step 1 of the USMLE examination.[12] E-learning has several advantages. Among the most important features, are that students can review the tenor at their own pace and repeat it as needed.[13] It must meticulously examine innovative medical education methods since they can serve as future inspiration.[14] It is clear from the review of local as well as international literature that several studies had been conducted to evaluate undergraduate medical students' perceptions toward e-learning, and there is no study had examined undergraduate medical students' perception of e-learning as part of their clinical surgery module during the COVID-19 pandemic. Such innovative education concepts encompass the online usage of blackboard and Microsoft Teams. As doubts on the utility of this novel educational method remain, the purpose of the present study was:

  1. To evaluate the student's perception toward a newly introduced online education in the surgical curriculum during the COVID-19 pandemic
  2. To comprehend the significance of e-learning in the surgery module during the COVID-19 pandemic
  3. To study the avails of distance means of learning in the surgery module from the perspective of students.

  Materials and Methods Top

A survey was conducted to investigate undergraduate students' perceptions of unexpectedly introduced e-learning tools in the surgery module. It included medical students during their course of surgery in the College of Medicine, University of Hail, KSA, for the 2019–2020 academic year.

While in a pandemic, because of social distancing, they received theoretical lectures using the Microsoft Team as distance e-learning. Participants had completed 32 distant online lectures. Students had been assessed during the course using seven sessions of online quizzes that comprised variable single best answer questions. The quizzes could be taken any place without physical attendance in the face-to-face classroom and without the teacher's presence. On completing the course, they received an Internet questionnaire after being briefed on the research purposes at the end of the course. Likert-scaled agreement questions were used to test the hypothesis.[15] As such, one stands for strongly disagree, two stands for disagree, three stands for undecided, four stands for agree, and five stands for strongly agree.

Microsoft Excel version 2016 spreadsheet was used to compile the collected data and SPSS 25.0 was used for analysis. Descriptive statistics were used to analyze responses to determine their frequency, mean, and standard deviation. A one-sample Chi-square test was conducted. In this study, cross tabulations and ANOVA were used to identify the differences between genders of students' responses to the inquiries “e-learning enhances the learning process” and “e-learning can substitute traditional means of education.” All significances were evaluated at a confidence level of 95%.

Ethics statement

The researchers handled the entire features of this study to make sure that questions allied to the precision or reliability of every section of this venture are properly studied and have been resolved and fixed when appropriate. All the measures for this study were rigorously organized with the approval of the Human Ethical Committee, University of Hail (HREC 00106/CM-UOH.04/20). Informed consent was signed by all participants.

  Results Top

The study included 72 students (42 males and 30 females), with a participation rate of 85.7%. Students contributed to the study through existing e-learning sessions. The first aspiration sought to quantify students' attitudes toward technology. The study has examined students' perceptions of online education by focusing on their own experiences. Other factors contributing to student perspectives on online education have also been evaluated. Data were divided into seven categories: (1) learners' knowledge, skills, and attitudes related to technology, (2) time management and implications of e-learning (3) perception of regular online quizzes, (5) communication with tutor, (6) students' perception to instructors, and (7) preferences for the future.

Learners' knowledge, skills, and attitudes related to technology

Students seem to have a positive opinion about the comfortability and usage of technology. The findings shown in [Table 1] display a significantly great level of respondent knowledge in using computer technologies with a mean score of 4.13 ± 0.992 (P < 0.001).
Table 1: Learner's knowledge, skills and attitudes related to technology

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As a result, they perceive the computer technologies as comfortable to use and have found that it meets their needs at home with a mean score of 4.06 ± 1.149 and 4.06 ± 01.086, respectively (P < 0.001). The most of the respondents stated that e-learning is easy to use with a mean score of 3.86 ± 1.052 (P < 0.001). There was no significant difference between male and female students regarding their perception of computer technologies knowledge and the availability to access the Internet (P > 0.05). Collectively, students had a positive perception of technology with a summated mean score of 4.024 ± 0.94.

Time management and implications of e-learning

It is noticed from the results in [Table 2] that over three-quarters of the participants (79.1%) have replied they spent less studying time than the time spent studying before the pandemic, and significantly they agreed/strongly agreed that e-learning saved learners' time without needs for lengthy-distance travel with a mean score of 4.14 ± 1.052 (P < 0.001).
Table 2: Attitudes towards adoption of e-learning in terms of time management and implications of e-learning

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About two-thirds of the respondents (65.3%) significantly believe in the possibility of e-learning to help learners to understand learning materials or lectures well with a mean score of 3.79 ± 1.087 (P < 0.001). Most students (63.9%) significantly expressed that the e-learning led them able to clear areas to focus on during the course with a mean score of 3.78 ± 1.103 (P < 0.001). Most students (61.1%) had significantly highlighted that e-learning might establish a cohesive and integrated trend in the medical education field as it helps in identifying areas of strengths and weaknesses in the knowledge with a mean score of 3.69 ± 1.109 (P < 0.001). Nearly, 66.7% of participants polled admitted that the use of e-learning in medical-surgical education has the advantage that it makes it easier for them to view presentations when they choose with a mean score of 3.88 ± 0.918 (P < 0.001), as well as 79.2% of them, had polled pointed out significantly that e-learning enables learners to keep copies of the presentations for use in the future (mean = 4.22±0.996, P < 0.001). Collectively, students had a positive perception of the implication of e-learning with a summated mean score of 3.92 ± 0.89. There was no significant difference between genders regarding their perception of the effects of e-learning (P > 0.05).

Perception toward regular online quizzes

The mean agreeability of the participants to online quizzes as it increases the level of knowledge, helps learners to identify knowledge gaps in the course, and it helps in better preparation for the final exam was above 3, and all standard deviations were fewer than 1.00. These high means and low standard deviations in each individual query in this regard as well as a summated mean score of 3.8264 ± 0.910, denote that the majority of participants have common beliefs in terms of the advantages of online quizzes.

[Table 3] shows that there are no significant differences in mean participation insight to regular online quizzes during the online surgery course between males and females (P > 0.05).
Table 3: Student's perception toward regular online quizzes

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Communication with tutor

A substantial number of the students had affirmed that it enables better quality of communication with tutors and believes that it was just like being in the room with the instructor with a mean score of 3.39 ± 1.33 (P = 0.039) and 3.07 ± 1.14 (P = 0.01), respectively.

Collectively, students had a positive perception toward e-learning as it maintains communication with the tutor with a summated mean score of 3.23 ± 0.71. There was no significant difference between genders regarding their perception of group and tutor communication of e-learning (P > 0.05) [Table 4].
Table 4: Communication with instructors

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Students' perception of instructors

At the beginning of the COVID-19 pandemic, it was difficult to actually train teachers in the manner required to teach online effectively as there was not enough time. Despite this, the student's answers were promising, with half of the students showing that teachers can teach effectively during the surgery course using distance online technology. In the same way, the study found that 53.9% of students admit that when instructors use computer technologies in the course, it adequately met their needs [Table 5]. When the students asked “What is your overall assessment of instructors' uses of computer technologies in your courses?” the majority (72.2%) responded positively, and there was no significant difference between genders, P = 0.211 [Figure 1].
Table 5: Student's perception to instructors

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Figure 1: The overall assessment of instructors' uses of computer technologies

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Mixed responses were received regarding the preferences of students for their next academic year. Most students (56.9%) expressed their preference for the combined (blended) teaching in the surgery module and 26.4% preferred a fully online course, whereas the minority preferred full classroom lectures [Figure 2].
Figure 2: Students' intention to use e-learning

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Despite the hype surrounding e-learning, when respondents asked, “Is it replacing traditional lectures?” Most respondents (65.2%) showed high agreeability with e-learning can serve as an adequate replacement for traditional classroom lectures (mean score = 3.65 ± 1.355) [Table 6]. On the other hand, when we asked, “which style of teaching do you prefer?” More than half of the respondents preferred the mixed (blended) style of learning.
Table 6: Student's preferences for the future

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The questionnaire ended by asking the students three questions about their definitive opinion about distance learning; “Do you think e-learning is a good idea for students?” 69.4% of the students had a significantly positive perception with a mean score of 3.81 ± 1.218 (P < 0.001), “Do you think e-learning is a good idea for universities?” 66.7% of the students had a significantly positive perception with a mean score of 3.79 ± 1.244 (P < 0.001), and “Are you interested in using e-learning?” 70.9% had a significantly positive response with a mean score of 3.83 ± 1.278 (P < 0.001).

  Discussion Top

The detrimental effect of the COVID-19 pandemic on health care is reflected in its effect on medical education spanning all levels from undergraduate studies to graduate evolution.[13] In response to technology education, the students develop knowledge and skills related to using technology.[16],[17] Many students in the surgery module in the current study expressed a positive point of view toward the use of technology during the learning process. This in part might be because the students in the surgery module are 6th-grade students, they trained themself in computer and Internet uses so their attitudes toward interest in information technology appear linked to student enthusiasm and contentment with technology education, as illustrated by several previous studies.[3],[13],[18],[19]

Over the centuries, the time has been addressed extensively, with different approaches expressed it is vitally imperative for all people in the world.[20],[21] Danish educators introduced time management as an educational instrument to assist people to organize their time more efficiently, and it soon grew to be popular around the world. This has become an important part of ensuring the success of learners today.[20] Most students spend between 10 and 30 h a week preparing for examinations, not counting consistent coursework (classes and reading textbooks). One or 2 h per course are required for this consistent coursework.[22] It can be said that the students in this study scored high levels in their awareness of time management through distance learning (mean, 4.14 ± 1.052), and there was no gender difference. Whereas some researchers determined that the students had modest score levels and female students outperformed their male counterparts in time management.[20]

Despite having differing opinions about how online learning affected content, most participants agreed it was beneficial to education with a mean score of 3.92 ± 0.89. This was in keeping with others.[23],[24],[25]

Effective communication between instructors and learners instantly resolves vague notions to augment student engagement and create a more dynamic learning circumstance.[26] In e-learning, teachers should structure and build their online classroom subjects to target learners. They ought to encourage cooperation and interactivities between them. The prosperity of e-learning also relies on how adequately and astutely the tenor is conveyed. Instructors' inspiration, cooperation, and practice are crucial to the efficiency of e-learning.[27] E-learning permits more opportunities to discuss and communicate, particularly with the instructors.[25],[28] The current study came out with the same fact that most students had a positive point of view toward e-learning as it enables good quality communication and interactivities with instructors and their peers.

The merit of the educational process in e-learning depends on many points, among which, is the degree of preparation that teachers have in utilizing innovative technology.[7] On account of the unexpected emergence of the COVID-19 pandemic, it was hard to prepare educators in good ways for e-learning strategies. Notwithstanding, the understudies' perception of instructors by means of technology usage was positive in the current study. Similarly, the findings from this study are in line with that of beforehand studies.[10],[29]

This online course comprised seven quizzes encountered during the surgery module. It was designed as a way not only to the assessment of the learners but also to enhance their learning process. The study found that the students mostly liked the idea of online quizzes as it increases the level of knowledge, help learners to identify their knowledge gaps, and let them gain new knowledge which helps them better prepare for the final exam. Concordant studies had shown that it can be incredibly effective to use quizzes in intensive courses having practical materials to get students to accomplish their reading and determine how much they have learned.[30] Whereas researchers who oppose online exams believe quizzes are unsuitable and ineffective because quizzes do not reflect the actual learner's ability. There is no guarantee that the recorded student is actually the one who carried out the task.[31]

Because of the many advantages, it offers to understudies, e-learning has become exceptionally popular among learners everywhere. It would, therefore, be alluring to implement them in all areas of education.[27] In a similar way, most respondents in the current study showed high concurrence with e-learning as an appropriate option to substitute traditional classroom lectures. Despite this, the majority favor the blended method of learning, this result is consistent with other studies in which students positively perceive the benefits of online learning and believe that the maximum benefit is achieved when applied in combination with traditional face-to-face learning methods.[25],[32]

  Conclusion Top

E-learning has various benefits. Through e-learning, surgical degree programs can be offered successfully. This cannot entirely supplant conventional methods of surgical training. However, the blended study is most likely to promote the training in the surgery module. Most students' responses to nearly all aspects of the questionnaire were positive. They can govern their learning time and punctuality to conduct the whole e-learning activities through the e-learning platform. We expect that the results of the current study will add to the efforts toward e-learning, which is expected to be the “new normal” in the future.

Limitations of the study

Current research has limitations, such as; students were abruptly encountered this innovative learning process, and from there, accurate cross-evaluations with conventional methods cannot be performed. The study was not generalizable because only a few students were involved. The learning outcomes of online students were not objectively measured. The findings need to be confirmed in larger multicenter samples.


The authors desire to show gratitude to all participants of students without them this work would not be fulfilled.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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