E-learning is mostly used in the learning process of the Medical Study Program during the pandemic. Lectures, practicum, skills lab and tutorials all done in the learning process. During the pandemic, the lecture learning process is carried out online, both synchronously and asynchronously. Synchronous learning either using MS Team or Zoom applications. Tutorials are carried out directly using the MS Team which are divided into small groups and facilitated by a tutor.
Based on the results, it is known that the average score of the learning evaluation test in online learning is higher than the results of the offline exam learning evaluation with a value of p = 0.024 this has an impact on the number of blocks passing which increases in online learning when compared to offline learning. The average online practicum response score is also higher than the offline practicum response test average score, this also has an impact on increasing the number of practicum graduations in the online learning process. The skills lab learning process is given synchronously and asynchronously. Before the synchronous meeting, students are given a video about the skills that students will do through MyKlass. They can access the video independently before synchronous learning is implemented. Although the skills lab learning process is carried out online, the assessment process is carried out offline. Surprisingly the result show that the OSCE score of students who take online learning is higher than students who take offline skills lab learning. This result is in accordance with the results of previous studies which stated that online learning outcomes were higher than offline student learning outcomes [3]. This is also supported by research conducted by [4] which states that students are satisfied with the learning system that uses e-learning during the pandemic. The existence of satisfaction will increase confidence and foster student motivation to learn. Attitudes, motivation, self-efficacy, and the use of technology play an important role in the cognitive engagement and academic performance of students which will later affect their learning process [5]. The learning process using e-learning is in accordance with the PBL learning method used in the Medical Study Program because this method requires students to become independent learning [6], the delivery of lessons can be in the form of simulations and real cases (Hartanto et al., 2020) and can ensure lifelong learning [7], and students can also access and learn without being constrained by place, space and time [8].
The learning process using technology, especially e-learning during the pandemic, is one of the alternatives chosen by various institutions, because this learning has many advantages, including 1) having relevant content to the learning objectives; 2) using instructional methods, for example presenting examples and exercises to improve learning; 3) using media elements such as words and pictures to convey learning materials; 4) allows direct teacher-centred (synchronous e-learning) or designed for independent learning (asynchronous e-learning); 5) build understanding and skills related to learning objectives either individually or improve group learning performance [9]. Although learning using e-learning has many advantages, there are 4 dimensions that can hinder its implementation, including (Naveed et al., 2017): students, among others, lack of motivation [5, 7, 10], self-efficacy [5] low bandwidth due to limited quota [11–14], do not have adequate online learning support facilities [12]. The second dimension is instructors, including not all educators can use technology in online learning [12], the techniques used are less varied [15]. The third dimension is Infrastructure and Technology, including inappropriate infrastructure, inadequate bandwidth and support personnel [16]. The last dimension is institutional management, including lack of funding and training support, unsupportive policies, and inappropriate instructional designs [16]. Therefore, so that the learning process using e-learning can be effective, the existing obstacles must be overcome. In addition, in developing this learning, cultural and contextual learning must be considered [17].