Student Experience of Distance Learning During the Sars-cov-2 Pandemic and the Prospects of its Use in A Medical University

Maria V. Sankova First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Vladimir N. Nikolenko First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Tatiana M. Litvinova First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Beatrice A. Volel First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Marine V. Oganesyan First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Andzhela D. Vovkogon First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Negoria A. Rizaeva First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Sergey V. Sankov First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Kirill V. Bulygin First Moscow State Medical University named after I.M. Sechenov (Sechenov University) Mikhail Y. Sinelnikov (  mikhail.y.sinelnikov@gmail.com ) First Moscow State Medical University named after I.M. Sechenov (Sechenov University)

Results. Almost all medical students possessed digital literacy skills and showed a high level of adaptation to online learning. Teacher technical skills de ned successful interaction with students in real time. The main di culties of remote education included technical di culties and problems associated with self-discipline and organization of working day regimen that should be taken into account when developing models of online learning. Physical wellbeing became a worrisome factor for many students.
Conclusion. Remote education, though e cient in theoretical education, cannot completely replace the traditional intramural education, mainly due to hands-on training requirements. However, in the future, a transition to combined medical education, where digital technologies will nd new prospects for application is anticipated.

Background
Medical training involves obtaining a large amount of theoretical knowledge, as well as professional practical and communication skills [1]. First-year medical students traditionally focus more on mostly theoretical subjects, such as human anatomy, histology and morphology [2,3]. Most subjects studied in medical school, require a substantial amount of practical (hands-on) experience, which is not anticipated to become obsolete [4]. Pre-pandemic medical training and student experience involved substantial focus on clinical and practical training, as well as a large number of group electives, social programs and study groups, which served as a foundation for the students' collective study efforts [5].
The ongoing SARS-COV-2 pandemic forced most medical universities to switch to remote education, to insure the safety of it's staff and students [6-8]. Many Universities implemented remote technologies prior to the pandemic, as extracurricular opportunities, which signi cantly eased the transition to remote education [9]. Nonetheless, rapid transition to remote learning affected the organization of educational activities, student management capabilities and complicated student assessment [10]. In order to de ne the positive and negative impacts of remote education, we evaluated students experience during the transition to a new format of education.

Results
Emergency transition to remote education during the period of rapid SARS-COV-2 spread was considered a relief by all students (100%). At Sechenov University, this became possible due to the presence of the Majority of respondents were familiar with such remote education technologies (passing tests and using teaching materials, lectures, electronic libraries, student portal), and every fth student applied to them regularly. Therefore, during transition to remote online education, almost all medical students had experience in using digital technologies for educational purposes. Almost half of all rst-year students were familiar with the University's own remote education platform, and approximately the same number of respondents previously worked with it. A very small portion of students had no experience with remote educational technologies. Most students (p <0.001) rated their adaptation to remote education as excellent and good ( Figure 1).
A fth of respondents were worried that transition to remote education would have a negative impact on their education, while 4.4% of freshmen doubted the e cacy of remote education. A majority of students (p <0.001) anticipated transition to remote education and claimed relief, since it signi cantly reduced the risk of infection with SARS-COV-2. The most popular electronic devices used by freshmen for remote education were mobile phones ( Figure 2). Laptops, tablets and personal computers were less in demand. According to respondent answers, the most reliable tools in noti cation and organization of remote online education were social networks and messengers and electronic mail: WhatsApp (83.8 ± 2.23%), e-mail (69.1 ± 2.08%) and vKontakte (55.9 ± 3 , 01%). For the implementation of collective video and audio communication, almost all students found Zoom to be the most convenient platform with the ability to visualize educational content, followed by Skype and Discord ( Figure 3). In student's opinion, the corporate Team platform and Adobe Connect software turned out to be the least convenient for organizing seminars. Most of the students (69.1 ± 2.71%) rated the knowledge and skills of their teachers in the eld of information technology as excellent and good ( Figure  4).
The most commonly used materials were lectures posted on the university portal (91.2 ± 1.72%), followed by online lectures read in real time (52.9 ± 3.03%). More than a third of freshmen (36.8 ± 2.92%) additionally used open resource materials to prepare for classes. Sending the text of the lecture and presentation to students was done very rarely -only in 13.2 ± 2.05% of cases. About half of the survey participants (52.9 ± 3.03%) reported that the workload during remote education did not increase. A quarter of the respondents (26.5 ± 2.67%) noted that it became easier to study, about the same number of students (20.6 ± 2.45%) indicated that it became more di cult.
Intermediate academic assessment was performed through teacher-student interviews (85.3 ± 2.15%), test examination (75.0 ± 2.63%) and individual projects (60.3 ± 2.97%). When passing nal examination, more than half of the respondents (54.4 ± 3.02%) noted that the session was easier than in traditional format, whereas 42.6 ± 2.99% of respondents did not nd signi cant differences, and only for 3.0 ± 1.03% found exams to be more di cult.
The majority of students (76.5 ± 2.57%, p <0.001) faced a number of di culties during remote education, the most common of which were technical problems, namely low internet speed and image quality. Every third respondent (33.8 ± 2.86%) noted poor audibility of the participants in video conferencing and the illegibility of their speech. The lack of necessary equipment for studying and practical skills caused anxiety among 13.2 ± 2.05% of students. Self-organization di culties (35.3 ± 2.89%) and low motivation (38.2 ± 2.94%) burdened remote education. 26.5 ± 2.67% of the respondents stated discomfort associated with being constantly at home. Every fth student (20.6 ± 2.45%) believed that the volume of homework assignments increased signi cantly during online learning. Only 16.2 ± 2.23% and 11.8 ± 1.95% of freshmen, respectively, complained about poor organization of information support and insu cient feedback from teachers.
Generally, assessing the effectiveness of their own work in a distance format, about half of the respondents (51.4 ± 2.03%) emphasized that due it did not change or became more effective ( All students saw the main importance of distance learning during the pandemic in that it allowed them to continue their education, while preserving the health of students and teachers during the period of the rapid increase in SARS-COV-2 incidence ( Figure 5). Among the disadvantages of remote education, most freshmen named lack of direct contact with teachers, lack of personal communication and student life ( Figure 6). Assessing the prospects of remote education at a medical university, only one sixth of the respondents were ready to completely switch to remote studying. Most students prefer a combined approach (Figure 7).

Discussion
The results of our study show that the emergency transition to remote education during the ongoing COVID-19 pandemic, was not burdened by signi cant di culties. Importantly, a vast majority of students were integrated into existing online educational resources and did not experience any inconveniences associated with adaptation to remote education, which is consistent with other reports [12]. Good technical skills and previous education in remote technologies allowed teachers to actively organize the educational process and interact with students in real time.
The main di culties of remote education faced by medical students included technical di culties and problems associated with self-discipline and the organization of the working day regimen. It is suggested to take into account possible self-discipline modulations in future application of remote technologies [13]. Due to home con nement, physical exercise, practical skills acquisition were burdened signi cantly. This should not be considered an issue of remote education, as it is a results of self-isolation requirements. Taken this into account, and according to the results of our evaluation, remote education generally offers greater liberty in the educational process, is less stressful for students and does not affect academic achievement. Despite this, practical lessons, crucial for medical education, cannot yet be transferred to remote education. It is suggested therefore to combined remote and intramural education modalities to create a comfortable and nourishing environment for student growth and study success.
Our study is limited by the single-center student evaluation via survey, which may have proved to be different in other specialized institutions. Nonetheless, the overall tendency of student perception of remote education is positive in terms of maintaining education while staying safe from the ongoing pandemic. Our results support the null hypothesis that remote education during the ongoing pandemic is bene cial to students, which suggest that further studies should focus on the e cacy of implementation of a combined approach (both remote and on-site training) in medical training.

Conclusion
The emergency transition of medical universities to remote education due to the SARS-CoV-2 pandemic was bene cial to both teachers and students. It provided a stimulus to discover new methods of medical education and was limited only by lack of hands-on training. Furthermore, this transition was supported by a vast majority of students, seen through students choosing isolation safety during the ongoing pandemic as a positive measure in their health preservation, while being able to continue their studies.
Our results further show that technologies are anticipated to become a standard educational format where applicable, as most students favor a combined (remote and on-site training) approach. under protocol №10-4-20. The study was carried out in accordance to relevant international and local regional guidelines.
Availability of data and materials: All data generated or analyzed during this study are included in this published article and its supplementary information les.
Informed consent was obtained from all subjects and/or their legal guardian(s).   Еlectronic devices used by students during remote education Students' assessment of teachers' knowledge and skills in the information technology eld Figure 5 Positive aspects of remote education Page 10/10 Figure 6 Negative aspects of remote education Figure 7 Prospects of remote education in a medical university

Supplementary Files
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