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 Table of Contents  
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 187-198

Learning human anatomy amid COVID-19 pandemic: Students' perspective

Assistant Professor, Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman

Date of Submission20-Jun-2021
Date of Decision02-Aug-2021
Date of Acceptance14-Oct-2021
Date of Web Publication28-Oct-2021

Correspondence Address:
Halima Albalushi
Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/NJCA.NJCA_85_21

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Introduction: Many countries adopted remote teaching upon the declaration of COVID-19 pandemic. Like many universities around the world, Sultan Qaboos University in the Sultanate of Oman shifted to emergency remote teaching (ERT) to contain the spread of the virus. In addition, anatomy classes were shifted to be taught online completely. This study aimed to explore students' perspective about the impact of COVID-19 pandemic on anatomy learning. Methodology: Students enrolled in anatomy courses during spring 2020 semester were asked to fill a questionnaire within 6 weeks of the end of online classes. The questionnaire included questions about students' perceptions and preferences about learning anatomy during ERT. Results: Findings indicated that coronavirus pandemic was disruptive to students' anatomy learning. Fulfilling courses requirements, home environment, internet connection, the anatomy knowledge without exposure to cadavers, and other resources in the lab were their main concerns. The reliability of internet connection was a major factor affecting their way of studying anatomy and selecting learning resources. Social media platforms were helpful in assisting students in their study and communication between themselves and their instructors. However, assessment and practical part teaching were not satisfactory to the students and they urge improvement. Conclusion: COVID-19 pandemic was disruptive to anatomy education. Internet connection was the major obstacles for the students, while the social media platforms were helpful tools in study and communication. Students urged improvement in the practical part teaching and assessment of the anatomy courses.

Keywords: Anatomy, COVID-19, medical education, online teaching

How to cite this article:
Albalushi H, Al Mushaiqri M, Al Jabri R. Learning human anatomy amid COVID-19 pandemic: Students' perspective. Natl J Clin Anat 2021;10:187-98

How to cite this URL:
Albalushi H, Al Mushaiqri M, Al Jabri R. Learning human anatomy amid COVID-19 pandemic: Students' perspective. Natl J Clin Anat [serial online] 2021 [cited 2022 Nov 30];10:187-98. Available from: http://www.njca.info/text.asp?2021/10/4/187/329503

  Introduction Top

Since the first recorded case in December 2019 in China, COVID-19 has caused an unprecedented global situation that has affected all aspects of daily lives.[1] Higher education was among the most severely affected sector by this pandemic. Universities were forced to end face-to-face teaching and move to remote teaching in an effort to prevent further spread of COVID-19. Certainly, this sudden change had major consequences on academics and students.

In Oman, Sultan Qaboos University (SQU) suspended studies for 4 weeks following the government order to end face-to-face teaching in schools and higher education institutes in the country. After that, SQU decided to start emergency remote teaching (ERT). Although evidence from literature suggested that well planned anatomy teaching solely based on online resources and textbooks is possible,[2] the quality of anatomy knowledge gained compared to hands-on and practical sessions teaching is debatable.[3] Acquiring anatomy knowledge in the laboratory using cadavers and models is considered the most effective method.[4] Students have access to many learning modalities other than cadavers when attending anatomy practical session in the dissection room. In the practical session part from cadavers, the students have access to other learning tools such as prosections, models, pathology specimens, and skeleton. All these became inaccessible to them in remote teaching settings. In recent years, cadavers had been used less widely in many universities for anatomy teaching due to many factors including the limited availability of donated cadavers and the time demanded to conduct dissection sessions in modern medical curricula. However, losing other modalities will affect the learning process and make it difficult for students to grasp the required anatomical knowledge.[5] Providing online learning resources might not be sufficient to compensate for abolishing hands-on practical sessions.

One aspect that is worth studying is the assessment of anatomy courses during ERT. In normal situations, the main modalities for anatomy practical knowledge assessment is oral viva exam[6] and written spotter examination,[7] which was not be feasible in the current situation. Students transited to online learning and assessment suddenly, without being prepared for the new strategy of assessment. The same challenge was faced by the instructors as well. Although some published work compared the wet and online practical examination of anatomy showed that student scored similarly,[8] the fast transition without enough preparedness warrants further investigations and more detailed studies. Moreover, some researches showed that the spotter practical examinations mainly test the recall skills in students.[9] Taking that into account, running the assessment online was a challenge to the instructors as they need to make the assessment more analytical and mainly tests understanding. Hence, COVID-19 pandemic provides us with a great opportunity to be innovative and adaptive to good assessment approaches by which accurate representation of students understanding and knowledge of anatomy can be examined.

Anatomy teaching during ERT phase had encountered many changes and challenges. The transition to remote teaching was shown to be disruptive to students and instructors[10] and their main concern was lacking of three-dimensional (3D) exposure.[3],[11] Recommendations to use proper, easy handled online resources were made by most researchers in this field.[3],[11] Moreover, the idea of exploring virtual reality anatomy resources was introduced and encouraged.[3],[12] It will be interesting to follow the research and see how remote assessment affects students' performance and anatomy knowledge acquisition. There is no published data on remote teaching and its effects on anatomy teaching in Oman or the gulf region. Exploring the students' perspective of this transition will pave the way for the improvement and adaptation needed in the coming period if face-to-face teaching is to be suspended or reduced and remote teaching to be practiced. In addition, it will help anatomy instructors in constructing a plan to utilize technology for future anatomy courses. This study examined how effective the modalities used during ERT in anatomy teaching from the students' perspective. The findings of this study might provide an insight into adapting easy methods that could achieve most effective course outcome.

  Materials and Methods Top

Study settings

[Table 1] presents anatomy teaching and assessment formats before and during ERT weeks of Spring 2020 semester.
Table 1: Formats of anatomy teaching and assessment before and during emergency remote teaching

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Study population and sample

A cross-sectional survey was conducted at SQU within 6 weeks of the end of spring 2020 semester. All 251 medical, nursing, and biomedical sciences students who were enrolled in basic anatomy courses were included in the study as participants. They were E-mailed the study questionnaire.

Data collection and analysis

The questionnaire of the survey was divided into two sections. First section of the questionnaire was about the demographic information of the students (gender, anatomy course enrolled in, and area of residence) [Appendix 1]. The second section of the questionnaire included questions about students' perceptions and preferences about learning anatomy during ERT [Appendix 2]. The questionnaire included items in a five-point Likert scale. These items took the form of opinion statements covering several aspects of anatomy teaching, including teaching methods, learning resources, student–instructor engagement, and assessment. At the end of the questionnaire, four open-ended questions were included asking students about aspects of anatomy learning during ERT such as the main challenges and recommendations for improving future anatomy online teaching. The qualitative data that emerged from this part of the questionnaire were analyzed using content analysis. The questionnaire was anonymous to keep confidentiality and to ensure data reliability.

Ethical consideration

The Ethics Committee of the College of Medicine and Health Sciences in SQU in Oman approved this study. All participants have been informed about the purpose of the study. They voluntarily gave their consent and participated in the study.

  Results Top

Students concerns during/about emergency remote teaching

The response rate to the questionnaire was 41.8% with 105 students returned a completed survey.

Sixty-six percent of students reported that they were following the coronavirus news very closely. Students were found to be concerned about many issues before and during the ERT period such as keeping up with the requirements of the course, having a good study environment at home, and having a good internet connection. Surprisingly, few students were worried about their connection to their professors and instructors.

Related to the anatomy course, 55% of the students reported that the pandemic was disruptive to their usual anatomy learning experience. Eighty-eight percent of participants reported that they were worried about getting enough exposure to cadavers. In addition, students were worried about the long-term consequences of the deficiency in learning anatomy that could be caused by ERT [Figure 1].
Figure 1: Students' concerns regarding anatomy courses during emergency remote teaching presented by percentage. Percentage represents number of respondents chose each statement to the total number of respondents

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The prime challenges faced by the students during emergency remote teaching

Half of the participants thought that the transition to ERT was smooth and they adapted to studying anatomy through ERT quickly. The majority (75%) felt that they received clear instructions about ERT, and 81% believed that they understood the differences between learning during face-to-face and ERT.

However, qualitative data analysis revealed that students were concerned about three main challenges that jeopardized their anatomy learning during ERT: time management, internet connection, and studying the practical component.

Students found it very difficult to manage time while studying from home. They expressed this in different ways such as “inability to correspond the time of the lecture listed in my timetable with my time at home,” and “inability to organize time” and “difficulty in managing my time at home.”

Many students also identified the inefficient internet connection as a second major challenge. They described it as “poor,” “bad,” “weak,” and “very very slow.” One student wrote: “I faced a lot of loss in internet connection during several quizzes and exams.” Another student had to “wait for a lot of time to upload one lecture” in addition to completely “losing network connection in some parts of the day, which affected (his) learning schedule.”

Recognizing that anatomy is a largely visual subject, students found it challenging to study the practical component of anatomy courses and “achieve the practical goals.” Many of them felt the need for physical presence in the lab when using the available study resources. Example quotes include the following.

“Understanding the anatomical structures in a cadaver and getting a feel of the human anatomy as a whole is different when observing cadavers.”

Anatomy learning resources during emergency remote teaching

Participants were asked about their preferences for theory and practical learning resources in future online teaching. For the lectures, they preferred PowerPoint slides with narration over the anatomy websites and applications suggested by instructors and the recorded video session [Figure 2]. Students felt that narrated slides were very helpful in many aspects, including them being “uploaded (in advance) at the beginning of the week,” students being able to “listen to the (them) any time,” and the possibility to “always rewind back and watch what was missed.”
Figure 2: Students' preferences for anatomy theory and practical learning resources during distant online teaching presented by percentage. Percentage represents number of respondents chose each learning resources to the total number of respondents

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Surprisingly, only 24% of them preferred the interactive live video sessions as a substitute for face-to-face anatomy lecture, while video-recorded lectures seemed to be negatively perceived by students. Example quotes are: “I felt lost when the instructor switches rapidly between slides in video recording” and “Recorded video was pit hard to control.”

Concerning practical classes, participants rated the recorded video demonstrations by instructors, anatomy websites and applications suggested by instructors, and PowerPoint slides with images and narration as the top three resources. Again, live video demonstrations came at the bottom of the list [Figure 2].

Fifty percent of the students preferred to use online anatomy learning resources for their anatomy learning. However, some of them requested to:

“Provide access to online anatomy websites that provide detailed atlases and 3D models which could help students easily study the theoretical part and compare it on a 3D model.”

Approximately only a third of the participants thought that online anatomy learning resources could compensate for the loss of face-to-face teaching classes.

Communication between students and instructors during emergency remote teaching

Participants were also asked about their preferences for communication with instructors and classmates during future online teaching. Social media applications (85%) and E-mails (63%) were the most preferred media for communicating with instructors [Figure 3]. They were also the most preferred method of communicating with classmates (91% and 21%, respectively). Moreover, approximately 64% of students would like to continue using social media platforms to communicate with their colleagues and instructors. Teamwork seemed to have been maintained during ERT as 69% of students either agreed or strongly agreed that they continued studying and communicating with the same group of students, they studied with before ERT. Communication was identified as one of the most satisfying aspects of teaching anatomy during ERT. Communication with the instructors and with fellow students were both praised. Example quotes are:
Figure 3: Students' preferred communication methods with instructors and classmates in distant online teaching presented by percentage. Percentage represents number of respondents chose each method to the total number of respondents

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“The fact that you can always send your instructor a quick question and get the answer in a matter of minutes was definitely a delight” and “(I liked) the communication between the student and instructor to find the best solution for the current ERT.”

Although 78% of the students reported that they were satisfied with the communication they had with their course instructor, 74% of them thought that scheduling virtual office hours with the courses instructors is needed in case remote teaching continues.

Assessment during emergency remote teaching

About 68.5% of the students thought that the assessment was suitable for the type of learning and teaching they got during the ERT period. Seventy percent of them reported that it motivated them to study hard and manage their time [Table 2]. Many of them praised the overall assessment through quotes such as: “The assessments helped me to study harder” and “(The tutor) put a good assessment plan which made the objectives very understandable to us.”
Table 2: Students' responses to items regarding assessment methods during emergency remote teaching

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Others commented on a particular type of assessment including the continuous summative assessment in the form of quizzes and assignments: “(I liked) preparing small quizzes each week, so that let us learn the week objectives well,” and formative assessment in the form of daily MCQs posted on social media platforms “I liked how (the tutor) used BAND questions to assess our knowledge after each lecture. It was very interesting, and I can say that I learned from them a lot.”

However, only 18% of participants strongly agreed that synchronous online exams were as good as conventional in-campus exams. Moreover, only 15% of them thought that these exams were fair to assess students' performance. On the other hand, about 69% of the students agreed that their final marks correspond to their efforts [Table 2].

On assessment feedback, students demanded proctoring of home exams to ensure fairness of the examination process as one student commented: “exams should be monitored by software or webcam to decrease likelihood of cheating.” If this is not possible, “in campus exam is excellent” or “change the assessment to open book exams.”

A summary of all the qualitative data is presented as a concept map in [Figure 4].
Figure 4: A concept map presenting a summary of the qualitative data related to students' perceptions about learning anatomy during emergency remote teaching amid COVID-19 pandemic

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  Discussion Top

This study presents medical students' perceptions about the impact of the transition to online teaching at the beginning of the COVID-19 pandemic in 2020, on their learning of human anatomy.

It has been reported that public health emergencies can affect college students psychologically, causing anxiety, fear, and worry.[13],[14] The current study found that students were worried and anxious about the pandemic situation. Literature indicated that home environment and internet connection availability are among the common concerns and challenges when adopting online learning.[15],[16],[17],[18] Similarly, the concerns among our students can be partly attributed to the demography of the Omani family. In Oman, most of the families are large extended families with more than seven persons/family in average,[19] which could mean limited study space less protected study time. Despite having most of the students in the capital (Muscat) and the nearby governorates (72%) during the ERT, students were concerned about the internet connections. Internet connection during the pandemic is an ongoing issue of concern to many sectors, including those related to learning at the college and university levels. This issue needs to be considered when planning for online learning in the future, especially if live sessions, live activities, and synchronous assessments are used.

The small percentage of students concerned about being infected or having someone in the family infected can be explained by a lack of information about the coronavirus, its lethality, and mode of transmission at the beginning of the pandemic. Moreover, at the time when the study suspension was advised in March 2020, the number of cases in Oman was very small and no deaths were reported yet. Therefore, at that time, students were more concerned about their studies rather than the situation itself. In this regard, about 65% were concerned about their ability to keep up with the demands of course requirements.

The finding that more than half of the students described the pandemic as disruptive to their anatomy learning was not surprising after knowing that 89% of the students were worried about not getting enough exposure to cadavers and other learning resources in the anatomy lab. Literature shows that the use of cadavers and models in the laboratory is considered the most effective method of learning anatomy.[4] Moreover, the quality of anatomy knowledge gained without the exposure to cadavers and models is debatable.[3] Therefore, there must be prior planning for future online teaching to provide enough learning resources to compensate for the loss of face-to-face teaching in the anatomy lab. This is supported by evidence from the literature showing that with well-planned online courses and resources, anatomy learning is possible and achievable.[2],[20]

Positive feedback in adapting to the transition to the ERT reported by the students reflects their ability to use technology in their learning and be self-directed learners. These skills and abilities are a great asset to them later on as medical professionals.[21],[22] This should encourage medical schools to consider online learning in their curricula even after the pandemic. In addition, students showed that they were capable of adapting online learning strategies and modalities, which should be considered as a positive indicator of the suitability of integrating online teaching in some courses in the future.

We found that more than 70% of the students preferred the recorded presentations as a substitution for face-to-face lectures. The recorded videos rather than the live interactive sessions were substituting the practical sessions during online teaching. We presume that the unreliable internet connection, which made it difficult to keep pace with live sessions, could be the reason behind this preference. However, the small proportion of students who preferred live-recorded sessions may not have internet issues and find the live sessions better to clarify their queries and grasp knowledge. More efforts should be made to address this issue as internet availability affects the mode of learning, leading to less interaction between the students and their instructors. Collaboration with telecommunication companies and higher education institutes is mandatory to provide good internet connection and offers to students.

Preferences of more than half of the students to use social media platforms to communicate with their classmates correspond with the role played by social media platforms during the pandemic for social, learning, and work purposes. Social media was shown to be the source of information and communication during the COVID-19 pandemic.[15] It seems that students could work with their friends through these platforms as they used to do before the pandemic, which helped them reduce the stress of the new situation.

Keeping the communication between the students and their instructors is mandatory for a good learning outcome. It has been shown that this is a challenge in online teaching as direct communication and feedback is disrupted compared to face-to-face teaching and learning.[15],[23] Although majority of the students were satisfied with the communication they had with their course instructors during the ERT period, they preferred to have scheduled virtual hours with their course instructors if remote teaching continues. Having scheduled virtual office hours will help students and instructors plan their time. Students want to feel that there are specific hours for them to communicate with their instructors. This may reduce their stress, knowing that their instructors have scheduled a specific time to answer their questions and clarify any misunderstanding that they might have.

With regard to assessment, the two least satisfying aspects were the appropriateness and fairness of synchronous online exams in assessing the actual students' performance. We believe that this refers mostly to the final exams and may possibly be attributed to the fact that the exams were not proctored and extended time per question was given to overcome internet connection issues. All these factors contribute to the feeling that exams were not fair for some students. A recent study from Oman found that academic dishonesty and technical infrastructure were among the main challenges of remote assessment.[24] It has been acknowledged that moving to online assessment, especially in anatomy courses, is complicated due to the practical and visual nature as a discipline.[23] Therefore, more work and curriculum modification are needed to make the online assessment suitable for proper students' performance and understanding assessment along with maintaining the integrity of the assessment process,[15] which is an ongoing debate that was revived by the COVID-19 pandemic.[25]

  Conclusion Top

COVID-19 pandemic was disruptive to more than half of students' usual anatomy learning experience. Students faced many challenges to excel in their study during the ERT, including internet connection, home environment, and time management. Internet connection was a major obstacle that influenced learning and teaching strategies. Students were mostly concerned about not having enough exposure to resources in the anatomy lab and demanded the implementation of more suitable alternatives. Therefore, careful planning for such alternatives should be seriously considered for future online anatomy courses.

Overall, students were satisfied with most aspects of the assessment of anatomy courses during ERT. However, a minority raised concerns about the fairness of unproctored synchronous online exams, which is a well-known deficiency of such assessment method. Overall, the outcome of this study emphasizes the need for collaboration between different stakeholders toward proper planning for a successful adaptation to online learning. Moreover, further research is warranted to trace the long- and medium-term consequences of the impact of COVID-19 pandemic on anatomy teaching locally and globally.

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Conflicts of interest

There are no conflicts of interest.

Appendix 2: The main questionnaire

  • What are the main challenges you faced during the online teaching weeks of this course?
  • What are the strategies used by the instructors of this course during the online teaching weeks that you liked the most?
  • What are the strategies used by the instructors of this course during the online teaching weeks that you disliked the most?
  • What changes to this course and future anatomy courses would you recommend if online teaching continues in the future?

  References Top

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2]

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