Our study on the satisfaction of Indonesian anatomy lecturers and medical students on online anatomy learning showed that generally, most of them were satisfied in three aspects, i.e., learning materials were well delivered and understandable, sufficient time allocation, and good time management. Differ with the offline method, online learning enables the lecturers and students to face the monitor and share contents via share screen. Therefore, the learning materials can be accessed better. Moreover, the learning interaction can be recorded, which allows students or lecturers to re-watch if needed. These results agree with the study results by Light and Pierson, who affirmed that online classes could facilitate learning material distribution effectively [9]. Satisfaction in time allocation and time management were thought to be associated with the prime characteristic of online class, namely, flexibility [10]. Moreover, online classes allow students to be able to understand materials at any time they prefer and to discuss them later with peers [11].
There were differences in the perspectives of lecturers and students regarding of whether there were problems in implementing online classes (lectures). Most of the lecturers (69.7%) claimed that no issues occurred during online classes; this is significantly different with only 36.4% students who agreed with this statement. Consistent results were seen in the data based on Indonesian regions. Challenges in performing online learning are the internet connection quality and poor utilization skills in online technology support [12]. There were some typical issues usually faced by students when attending online classes, such as less intensive communication, overloaded tasks, unskillful use of technological tools, anxiety and stress (probably due to the pandemic situation), physical problems, and technophobia [13] [14]. This difference in perspectives arose because lecturers seemed to have a difficulty in assessing students’ learning progress during online classes [6]. Incapacity for that process had disallowed lecturers to identify any issues that hindered student progress during online classes. Thus, it is recommended to provide tutor and student guidelines for online teaching and learning activities, including any aspects related to the student learning process during online learning.
There was a similarity in perspectives between lecturers and students that online anatomy practical sessions were still problematic. A plausible reason for this phenomenon is the hands-on nature of the anatomical course [15]. Conducting online practical sessions is a challenge for lecturers, because they must prepare audiovisual learning media while previously they should only use mannequins or cadavers. More than half of the students (63.3%) admitted that a number of issues arose during online practical sessions, due to the students’ inability to experience real-life anatomy and to perceive how the actual organs are located in human body. Study of Potu et al. showed that majority of the students (57.4%) preferred offline demonstration to understand the spatial orientation of the organ systems and to get a visualization of relations between structures [10]. In fact, cadaver is one of the most important practical media to help students learning about human body system in reality, as it provides 3D visualization. Using cadavers is highly expected to effectively help prospective doctors enhancing their surgery skill, professionalism, recognition of real human body organs, and teamwork [16]. The pandemic caused an absence of cadaveric dissection practical sessions. According to Ooi and Ooi, an anatomy practical sessions without the use of cadavers might cost students lost opportunities for doctor’s professional skill development, professionalism enhancement, ethical competence improvement, and self-confidence acquisition when working in surgery rooms. Besides, the absence of cadaveric media for practical sessions might also cause a loss of chance for students to sharpen their teamwork skill. Because of these potential effects, students and lecturers admitted that they were less satisfied with the online practical exercises, which lead to a consideration in planning the prospective practical sessions in the new normal era, by reincluding the use of cadaveric media.
Next aspect is related to the improvement of student’s interest in online classes. Most of the lecturers (72.7%) opined that student’s interest increased during online class. However, the claim opposed to what students perceived. A total of 62.6% of students disagreed that online classes had motivated them to learn. These results were consistent with the results based on regions. These findings are also consistent with the research carried out by Adnan and Anwar, who found that 74% of students disagreed that online classes were more motivating than conventional ones [17]. This perception appears to be the reason online classes might demotivate students to learn. Yunitasari and Hanifah found that the COVID-19 pandemic affected student’s motivation as they felt bored and could not be involved in live interaction that was experienced in the face-to-face learning [18]. Another probability causing a student's demotivation is overloaded projects/tasks. Surveys on 68 medical students in Germany had demonstrated how students became so permanently stressed during COVID-19 due to excessive emotional fatigue, especially when examination was approaching. It forced them to spend the whole time studying, and sacrifice other routines, including their time for rest [19]. Moreover, online class is also a cause of excessive anxiety and a source of stress to students. Alsoufi et al. asserted that around 31.3% of medical students in Libya were highly prone to depression, and the other 10.5% suffered from anxiety symptoms [20]. More seriously, it was also reported that most students were demotivated to learn during the pandemic [6].
Interesting results are found in the aspect of interaction between lecturers and students. In general, more than 50% respondents agreed that during the online anatomy learning, lecturers and students had a good interaction. However, based on the regions, respondents who agreed were from Java, with a percentage 62.2% for the lecturers and 72% for the students, compared to those outside Java, i.e., 33.3% for the lecturers and 45.9% for the students. The most probable cause was the level of internet penetration in Indonesia. In 2020–2021, Java was the island with the highest number of villages that were able to receive cellular phone signals and with a strong signal reception in Indonesia, amounting to 99.96%, followed by Sumatera (98.61%), Bali and Nusa Tenggara (98.63%), Sulawesi (95.79%), and Kalimantan (93.60%). Maluku and Papua were the regions with the fewest signal receiving villages [21]. In online activities, internet signal strength and the availability of receiving devices (such as smartphones and computers) are prerequisites for the smooth running of learning activities. Further, most of the lecturers also felt uncomfortable with online classes, which was the cause of ineffective interaction, as well [7]. Similar conditions have also been reported in India. Kumari et al. reported that a majority of students in the Medical College of Jharkhand India experienced network issues (53.89%), whereas, Sarkar et al. with respondents from various universities in India reported internet difficulties experienced by 42.06% of the students. Other hindrance factors, such as personal communication skill, direct communication limitation, and other reasons can also be potential factors that are needed to be evaluated [14][22][23].
After the pandemic, both lecturers and students chose a combination of online and face-to-face learning (blended learning) to be carried out and continue the practical learning activities using cadavers. Respondents from Java thought that they needed a repetition of learning anatomy, especially the practical anatomy sessions. Whereas outside Java, apart from repeating the practicum, they also need additional lectures on certain topics (special lectures). The decision might be directed by the fact that both online and offline (face-to-face) learning activities have their advantages and disadvantages. From this research, the majority of respondents agreed that online learning had advantages, i.e., materials were well delivered and understandable, time could be allocated sufficiently and manageable (more flexible). Nevertheless, there were disadvantages, such as limitation of lecture and student interactions, problems in its implementation, both for online classes and practical sessions. These issues will finally influence the motivation of the students. Low student motivation and less optimal interaction among students become the key reasons that encouraged students and lecturers to choose mixed methods, combining online and offline modes. Similarly, previous research reported by Potu et al. that 57.40% and by Rajab et al. that 62.5% of students agreed to undertake a blended learning model [10][13]. Furthermore, there were results of surveys in which the respondents chose online or face-to-face learning only. Thomas et al. claimed that about 55% of students preferred conventional classes to the online ones, and 51.7% of students were found not expecting to rejoin online learning after the pandemic is over [24]. In Lahore, Fatima et al. reported that 59.5% of respondents valued face-to-face learning more than online learning. In India, it was reported that 68.86% [22] to 98.41% [14] of respondents agreed that traditional teaching was better than online anatomy teaching.
The COVID-19 pandemic has caused changes in the majority of life sectors, especially education. Before the pandemic, education was normally held in a traditional setting – face-to-face. Such method allowed students and lecturers to interact with one another to develop favorable social interaction between the two. Furthermore, social interaction could generate active participation in team working, allow students to help each other in doing the assignment, and understand each other through facial gestures, so that essential points of learning could be acquired [25]. Unfortunately, the pandemic changed everything, and such a normal activity could not be held anymore. Therefore, in response to the current condition, modification on the learning method used is highly needed, by combining online and offline class activities. Basically, the implementation of exercises in online classes needs to consider some crucial aspects, such as technology, finance, infrastructure, institution, educators, internet connection quality, and family distraction, which possibly gives impact to the success of online classes [11][26]. Further, a number of research demonstrated positive results on online classes. In fact, the majority of students preferred online to offline classes due to its flexibility so that learning could be accomplished anytime and anywhere [27]. It was also supported by Febrianto et al. who claimed that efficiency and flexibility were the major reasons why online class was promoted [28]. In addition, with online classes, students could still have open access to skill and knowledge enhancement without having to worry about the risk of coronavirus infection [29].