We investigated the various aspects of the e-learning experience by the students of medical science colleges in Saudi Arabia during the Covid-19 pandemic as regard to the technical preparedness, teaching and learning experience, interaction and communication, and assessment methods. The study demonstrated that a relatively higher proportion of the respondents 58.2 % agreed that they had enough information about the e-learning platform. However, less than 50 % of the total participants agreed that they received adequate guidance and technical support during the e-learning process. It is well known that the success of the e-learning program depends largely on the learning tools and the technical support available for the users [16].

The e-learning standards for Higher Education in the Kingdom of Saudi Arabia were built according to the best-known international standards that include technology, training and support, design, interaction, equity and accessibility, and assessment and evaluation [17]. Every e-learning system establishes its basic foundation of computers, networks, communications and technical facilities along with information communication technology professionals to continuously maintain and upgrade the system, train the users and provide technical support [18]. Appropriate technological support and maintenance of the available hardware and software is of great value for utilizing the technology by educators and students up to the optimum [19,20,21]. Personal hardware and internet access in the current study were reported to be satisfactory for the learning process by 35.5 % in contrast to 44.1 % who thought them to be unsatisfactory. A larger proportion of the study’s respondents agreed that easily accessible online teaching materials for all courses were made available in a timely manner during the study period. It has been stated that the success of the online education program is related to the provision of adequate levels of educational guidance and technical support [22, 23].

In this study, we noticed a significant variation in the fulfillment of technical requirement of the e-learning process within the various colleges and regions. Dentistry, applied health sciences, and public health colleges were the best prepared for e-learning because of their previous experience prior to the COVID-19 pandemic [24]. The variation between regions is proportional to the socioeconomic parameters of the different regions [25].

Evidences for the equivalency of e-learning to traditional methods with respect to the learners’ achievements in knowledge widely exist. However, the current findings do not fully support this, since nearly half of the respondents did not agree on the similarity of e-learning and traditional classes in terms of achievements of learning outcomes. Most of them mentioned the unsuitability of e-learning for the health sciences studies. In addition, a significant difference in the learning experience was detected between age groups, colleges, and region. Older age group of  30 who are mature students and enthusiastic younger ones of 18–21 years who are in the first years reported the best valuable learning experience.

e-learning modalities that are flexible and effective sources of teaching and learning cannot be free of some adverse circumstances. According to the educators and students, e-learning is a flexible and effective source of teaching and learning that helps in distance education with less use of resources and time. The flexibility of e-learning over face-to-face teaching has been reported in the literature previously. This makes the students to become self-directed learners, an important competency for supporting lifelong learning among health care professionals [26, 27].

The majority of our respondents considered that e-learning is unsuitable for the health sciences studies. Several meta-analysis studies have demonstrated that learning at a distance in health-allied sciences is as effective as traditional classroom instruction [28, 29]. However, some barriers or challenges exist. Faculty members and students said that through e-learning modalities, practical and clinical work are not properly taught and learned.

Barriers and challenges of e-leaning modalities are many. One of these is poor motivation and an expectation to be able to meet their personal and professional needs and goals [30].

Internal factors such as poor engagement, poor perception and motivation, high levels of anxiety and stress, and poor interactions between learners and facilitators hinder the process of learning and motivation [31, 32].

Most of the participating students in the current study admitted that they gained a good understanding of the courses learning outcomes during the e-learning experience. This was considered to have been a valuable outcome. It has been stated that well-designed virtual learning may result in more effective learning in comparison with the traditional face-to-face training [33]. The majority of our respondents did not agree on the similarity of e-learning and traditional classes. Many studies reported no significant difference between the two teaching methods. Overall, it has been suggested that e-learning is at least as effective as traditional face-to-face learning. However, others showed that e-learning was better than offline learning [34, 35].

In this study, the majority of students disagreed on the effectiveness of the virtual practical sessions as a replacement for real laboratory training. It has been recommended that a blended teaching strategy that includes in-person laboratory training is more appropriate.

Virtual laboratories, and video-based laboratories are better choices when students are not physically located on campus [36]. It has been stated that online teaching and laboratory practices in the biosciences field is often more effective than traditional based learning [37].

A large proportion of the participants of the current studies have considered e-learning as a stressful experience. In a cross-sectional study among Saudi Arabian medical students, pandemic-related anxiety and stress were specified among the challenges [38]. Most of the participating students in this study stated that they would not like to take more e-learning more classes if they were given the option. Stress has been many times associated with e-learning than with traditional learning [39, 40]. Increased concerns in academic performance as a stressor contributing to increased levels of stress, anxiety, and depressive thoughts among students due to the COVID-19 pandemic situation was previously identified [41].

A large proportion of our participants admitted their ability to interact effectively with the instructor and even more of them were able to interact with other students during the e-learning classes. There has been a great concern that the physical interaction during online courses is not up to the standard which might affect the learning outcomes [42]. However, meaningful interaction between educators and students can be achieved in online courses through discussion forums [42]. Encouragement of interaction during the online classroom is an important thought to ensure the active knowledge [43]. While students indicated that the interactive components of the course were valuable, several areas in which improvement may be made remain, such as lack of participation on the part of fellow students in discussion and inability to attend synchronous sessions due to course scheduling conflicts [43].

Several studies have provided evidences for the relationship between student-student interaction, student-educator interaction and academic emotions and learning persistence [44, 45]. It has been proposed that student-student discussions could boost higher levels of knowledge construction and learning outcomes in student-student discussions [23].

Our findings detected a significant difference in the interaction and communication during the e-learning experience between age groups, colleges, and regions. Again, the older age group of  30 and younger ones of 18 -21years reported their ability to better interact between educators and among themselves during the online classes. Dentistry, Applied Health Science and Health Sciences College have reported better interaction and communication than their peers in other colleges. Similarly, the central and Eastern regions have shown better interaction.

An appreciable number of the participants (42.4 %) regarded their instructor’s feedback on their work and progress as poor. Feedback is an important component of effective learnerning [46]. Feedback provision supports the opportunity for enhanced academic performance. Meaningful feedback on assignments enhances critical thinking, reflective practice, and develops educator-student relationships which is important in an e-learning process.

Another adequate number of 44.2 % considered the overall assessment plan as satisfactory. Although many considered that the examination process was clear to them, a large number regarded the online examination process as unfair, mostly due to the intentional short duration of the examination period. Student satisfaction is important because it predicts student retention and is linked to the student’s learning outcomes [47]. Varied results have been reported when comparing student satisfaction in face-to-face and online courses [48].

Part of the study included open-end questions to obtain detailed responses and real insights. Our respondents mentioned the flexible accessibility of the learning materials, time, effort, and money saving, acquiring and improving technical and self-learning skills: Self-learning / Improvement in technology skills, safety from COVID-19, good interaction between the instructor and students with no shyness, and better academic accomplishment. On the other hand, disadvantages and difficulties included inadequate tools to facilitate e-learning, poor internet connection, lack of technological skills by the educators and students. Also there was inadequate or lack of practical classes, lack of a unified clear policy for the conduct of online classes and exams and grade distribution, limited online exam time. Other difficulties mentioned included lack of body language and eye contact and direct communication and active discussion. Additionally there were distractions, lack of motivation and anxiety, ineffectiveness of online practical, and unfairness of assessment methods due to cheating.

Several suggestions were mentioned for improving the e-learning process. These included the use of blended learning strategies that include an in person practical/clinical training. Other suggestions included staff and student’s technical training, more use of visual training materials, more time for exams with multiple attempts, the existence of examination policy during internet disconnection, the use of an effective system that detects and prevent cheating, and encouraging active interaction between the instructor and students. To avoid the potential limitations of e-learning in undergraduate medical education, it might be worthwhile to combine the advantages of online and offline teaching methods, called blended learning [49]. However, there is still a need for more scientific evidences for clear comparison between online and traditional learning, since most experimental designs of the previous research articles varied in terms of participants, learning goals, intervention durations, and forms of e-learning, etc. It has been suggested before that the low use of social networking sites for sharing information along with the great variations in the medical student’s perceptions about social media should draw attention of the concerned institutions to advancing awareness and educational transforms [50].

The main limitations of the study is the cross sectional design and the small sample size. Another major limitations of our study was the possibility of recall bias of our respondents.

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