Adaptation to e-learning among medical students: a comparison of two Asian countries

Adaptation to e-learning among medical students: a comparison of two Asian countries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adaptation to e-learning among medical students: a comparison of two Asian countries Thilanka Seneviratne, Chiara Marie Miranda Dimla, Kaumudee Kodikara, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6669568/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Due to the COVID-19 pandemic, universities have shifted to offeringe-learning for their students from traditional face-to-face learning, which continues to varying degrees to date. With the current trend for hybrid learning, learner perceptions and factors contributing to effective e-learning need to be identified to improve the student learning experience in medical schools. The present study aimed to describe medical students’ perceptions ofand readiness for e-learning after the pandemic. The insights gained will enable educators to create mechanisms that can enhance learners’ attitudes and readiness for adopting e-learning platforms for their education. Methods: A self-administered online survey with medical students in the third, fourth and fifth yearsof study in two countries,the Philippines (PH) and Sri Lanka (SL), was conducted. Six hundred fifty-one (651) medical students across four medical schools responded. Descriptive statistics were used to analyze the data. Results: Students from both countries valued e-learning for its time-saving nature (PH: 57%; SL: 79.8%) and relaxed nature of the learning environment (PH: 55.4%; SL: 62.5%). Students from both countries preferred recorded lectures (PH: 63.2%; SL: 52.7%) over live-synchronous lectures. Although students from both countries demonstrated high levels of readiness for self-directed e-learning, Philippine medical students preferred face-to-face lectures over live synchronous or recorded lectures (PH: 295, 63.2%; SL: 97, 52.7%; p<0.01). Filipinos felt that e-learning was more stressful (PH: 293, 62.8%; SL: 29, 15.8%; p<0.001). Most students from both regions faced connectivity issues (PH: 63.5%; SL: 61.4%). Overall, SL medical students reported a more positive attitude toward e-learning (median score: PH: 3 (0.84); SL: 4 (1.00); p<0.05) and felt better adapted to e-learning (PH: 3 (1.03); SL: 4 (1.13); p<0.05) than their Filipino counterparts did. Conclusions: The results revealed that students in the two different countries under study had different perceptions and psychological behaviors toward e-learning despite demonstrating high computer self-efficacy. The study reveals the need for immersive learning experiences regardless of the pedagogical tools used to deliver medical education. The challenges medical students facein engaging in e-learning imply the need for medical educators and administrators to emphasize the effective use of technology for teaching and learning. e-learning medical students perceptions attitudes readiness Background In the wake of the COVID-19 pandemic, medical education has transformed radically to cushion the effects of the pandemic and revamp the education system by switching to e-learning [ 1 , 2 ]. While the implementation of e-learning has been deemed a time-intensive and expensive process due to the lack of infrastructure needed [ 3 , 4 ], medical schools worldwide have implemented e-learning to the benefit of the student fraternity to varying extents and, to a much greater extent, in more recent years since the pandemic [ 5 – 8 ]. E-learning has come to stay, with its merits being investigated widely during the pandemic [ 9 ]. E-learning has been shown to enhance knowledge gain through easy access to a large amount of information, promoting personal knowledge gain and knowledge sharing within and across groups [ 10 , 11 ]. E-learning has shown to increase learner satisfaction and decrease stress by enabling students to participate in teaching activities while being in their comfort zones [ 12 ]. Moreover, while most Asian medical schools relied on traditional teaching methods prior to the pandemic, they have integrated e-learning into medical education to varying degrees [ 13 , 14 ]. However, medical schools in this part of the world have experienced issues in adopting e-learning similar to the developed world [ 4 , 15 ]. A lack of skilled lecturers, social inequalities, a lack of infrastructure [ 16 , 17 ], high costs of internet data services and poor internet connectivity [ 18 – 21 ] were found to be prominent issues in the adoption of e-learning during the pandemic in Asia. A key aftereffect of the pandemic was the continued utilization of online learning platforms for teaching and learning activities. This universal experience highlights the pivotal role of internet infrastructure, digital literacy, and access to devices that enable online education [ 22 ]. Whilst learners adapted to e-learning in the face of the pandemic due to obvious health hazards associated with the traditional classroom, continued e-learning especially in undergraduate medical programmes where e-learning had not taken prominence prior to the pandemic warrants investigating learner perception and readiness for continuing this method of education effectively. Factors such as the perceived usefulness of e-learning, ease of use, pressure to use, good technical skills and the availability of resources needed to use e-learning have impacted students’ attitudes and readiness toward e-learning [ 23 , 24 ]. However, the assessment of user characteristics in e-learning systems, especially in South Asian and Southeast Asian regions, appears to be limited [ 25 ], despite being a prerequisite for introducing and sustaining successful e-learning systems [ 23 ]. The successful adoption of e-learning systems by learners requires a solid understanding of user acceptance processes with these technologies [ 26 ]. Hence, evaluating perceptions and attitudes becomes vital in analyzing consumer readiness to adopt, as favorable attitudes show a greater probability that learners will willingly accept new learning systems [ 24 , 27 ]. Acceptance of the new learning system will be worthwhile as earlier studies reported enhanced knowledge efficiency [ 10 , 11 ] and mean performance of users in favor of online education compared with the same course delivered face to face [ 28 ]. Since users’ views tend to impact the advancement of e-learning [ 23 , 24 ], understanding how students perceive and react to elements of e-learning and factors that influence readiness for effective e-learning is essential and timely [ 29 ]. However, the differences in context may alter the way the students embrace e-learning, making one plan fit all, a mission impossible. The two Asian countries under study, while both being developing countries, show significant contrasts in economic growth and development [ 30 , 31 ]. Interestingly, both countries have implemented e-learning to great degrees in higher education institutions at present, driven mostly by the COVID-19 pandemic [ 13 , 16 ]. Although the current situation might present a unique opportunity for continuing the modernization of medical education, the attitudes of students toward e-learning post pandemic need to be evaluated to deliver meaningful educational experiences to medical students. Thus, we aimed to describe the medical students’ attitudes and perceptions for e-learning after the pandemic to determine possible teaching scenarios for future medical education by comparing the responses of a sample of medical students from two different countries in the developing world. We conducted a multicenter study in Asia to provide a broad, scientific basis to guide the future development of e-learning in medical education in this region of the world. The findings of this study could inform academic administrators to adopt e-learning in improving medical education to create mechanisms that can enhance learners’ attitudes and readiness to adopt e-learning platforms for their education. Materials and methods Study sample and participants The study compared how medical students from the Philippines (PH), a Southeast Asian country, perceived e-learning two years post pandemic as opposed to South Asian (Sri Lankan, SL) medical students. For this purpose, eight state universities with medical schools in Sri Lanka were invited to participate in the study. Similarly, an invitation was sent to medical schools in the Philippines through a locally based coauthor. The inclusion criteria were evidence of transition to e-learning in the medical school with the pandemic and agreement to participate in the online survey. Consent was also obtained from the university administrators. Invitations to each student in their third, fourth or fifth year of study were mediated through the dean’s office using each medical school’s learning management system (LMS) and group chats (WhatsApp, Messenger, Viber). All the students voluntarily participated in the survey. In SL, the survey was distributed as Google Forms between February and March 2023. In the PH, the data collection was conducted via Google Forms in the month of May 2023. The responses were anonymous, but each survey was unique to that study participant and could not be shared or completed more than once. Ethical approval was obtained from the Ethics Review Committee (ERC), Faculty of Medicine, University of Peradeniya (ID: 2022/EC/60) and from the institutional ERC of the University of East-Ramon Magsaysay Memorial Medical Center (approval code: 1554/C/2023/126). Survey instrument Student attitudes and perceptions regarding e-learning were assessed via a questionnaire adapted from Bernard et al. (2004). The items of the study instrument can be categorized into nine main domains. 1) Demographic details (university, study year, gender), 2) e-learning methods (purely online or hybrid: in-person and online), 3) live-synchronous (Zoom/ Google Meet, etc.) and recorded lectures (asynchronous), 4) comparisons between physical or in-person classroom teaching and online teaching, 5) computer/internet self-efficacy, 6) self-directed learning, 7) learner control in an online context (time management), 8) self-motivation for learning in an online context, and 9) online communication self-efficacy [ 32 ]. Statistical data analysis The data were exported to Microsoft Excel and promptly cleaned. Descriptive statistics were used to analyze the survey responses. The statistical analysis was performed via SPSS version 22 (IBM, 2014) and Microsoft Excel. First, we tabulated and summarized the demographic characteristics of our study sample. Next, we examined the responses to each measure of e-learning experience. Independent t-test was used to explore the associations between variables. These tests were conducted following the Shapiro‒Wilk normality test, which revealed that the dataset was non-Gaussian in distribution. P values of < 0.05 were considered statistically significant. Results Demographic characteristics Three of the eight medical schools in Sri Lanka agreed to participate (n=188). One medical school from the Philippines responded (n=467). We collected data to guarantee their quality in terms of response time and country name. After data cleaning, the sample consisted of six hundred fifty-one (651) medical students from four (4) medical schools representing both countries. A greater proportion of females is observed in undergraduate medical programmes in both countries. Consistently, there was a higher response rate from female medical students in both countries. More responses were received from third-year medical students in both countries. Table 1 shows the participant characteristics of the study sample. Table 1 Demographic characteristics of the study participants Country Philippines/PH No. (%) (N= 467) Sri Lanka/SL No. (%) (N= 184) Gender Male 149 (32) 55 (29.8) Female 318 (68) 129 (70.1) Year of study 3 rd year 127 (27.2) 134 (72.8) 4 th year 315 (67.4) 17 (9.2) 5 th year 25 (5.4) 33 (18) Abbreviation: N, number of participants Overall, students in both regions reported that they experienced the following modes of teaching at specific time periods during and after the pandemic: 1) purely online (PH: 100%; SL: 100%), 2) hybrid (PH: 85.4%, n=399; SL: 100%), and 3) face-to-face (PH: 78.5%, n=367; SL: 100%). All institutions were using a hybrid mode to deliver the education at the time of data collection. Students’ perceptions regarding e-learning Students from both countries valued e-learning because of its time-saving nature (PH: 57%; SL: 79.8%) and the relaxed nature of the learning environment (PH: 55.4%; SL: 62.5%). Although most students from both countries preferred recorded lectures (PH: 63.2%; SL: 52.7%) over live-synchronous lectures, this preference was marked in Filipino students (p=0.01). Medical students from Philippines responded that they understood recorded lectures (PH: 61.9%; SL: 76.7%) better than live-synchronous lectures (PH: 37.7%; SL: 69%). The Sri Lankan medical students felt equally comfortable with both recorded lectures and live-synchronous lectures, with more than half of the students (50% to 69%) agreeing with the following statements regarding live-synchronous lectures: “able to understand content clearly", "interacting with the lecturer is easier than face-to-face lectures", and "motivated to ask questions than in face-to-face lectures". For the Philippine respondents, similar proportions, 38% and 39%, respectively, agreed and were neutral to statements "able to understand content clearly". Furthermore, the Philippine students did not find live-synchronous lectures to provide venue for easier interaction, nor were they more motivated to ask questions when compared with face-to-face lectures. However, in both samples, the majority agree that "lack of peer interaction is a significant issue" (Table 2). Table 2 Perceptions regarding e-learning, recorded lectures and live-synchronous lectures Philippines No. (%) Sri Lanka No. (%) p value Live-synchronous 172 (36.8) 87 (47.3) 0.01 Recorded 295 (63.2) 97 (52.7) Philippines No (%) Sri Lanka No (%) SA/A NS D/SD SA/A NS D/SD Regarding e-learning Is time saving 265 (57) 80 (17.2) 120 (25.8) 147 (79.9) 24 (13) 13 (7.1) Is student centered 111 (23.8) 161 (34.4) 195 (41.8) 112 (60.9) 27 (14.6) 45 (24.5) Learning atmosphere is relaxed 258 (55.4) 96 (20.6) 112 (24.0) 115 (62.5) 50 (27.2) 19 (10.4) Encourages active learning 141 (30.2) 111 (23.8) 215 (46) 75 (40.7) 61 (33.2) 48 (26.1) Ensures better concentration to learning material 80 (17.1) 111 (23.8) 276 (59.1) 91 (49.4) 48 (26.1) 45 (24.5) Is stressful 293 (62.8) 105 (22.5) 69 (14.8) 29 (15.8) 54 (29.3) 101 (54.9) Regarding live-synchronous lectures Able to understand content clearly 176 (37.7) 184 (39.4) 107 (22.9) 127 (69) 41 (22.3) 16 (8.7) Interacting with the lecturer is easier than face-to-face lectures 119 (25.6) 102 (21.9) 246 (52. 6) 100 (54.4) 48 (26.1) 36 (19.6) Motivated to ask questions than in face-to-face lectures 135 (29.0) 136 (29.1) 196 (41.9) 101 (54.9) 59 (32.1) 24 (13.0) Lack of peer interaction is a significant issue 352 (75.5) 52 (11.2) 62 (13.3) 92 (50.0) 51 (27.7) 41 (22.3) Regarding recorded lectures Able to understand content clearly 289 (61.9) 128 (28.4) 50 (10.7) 148 (76.7) 31 (16.1) 14 (7.3) Preferred over face-to-face lectures 187 (40.0) 112 (24) 168 (35.9) 104 (56.6) 40 (21.7) 40 (21.7) Abbreviations: SA, Strongly Agree; A, Agree, NS, Not Sure, D, Disagree; SD, Strongly Disagree The students in both regions identified significant drawbacks in e-learning. Table 3 presents the issues students encountered during e-learning. The Filipino students stated poor internet connectivity, high data charges, and poor video/sound quality as the top three issues they faced that affected their engagement during e-learning. The same issues were noted among the Sri Lanka students except for poor video and sound quality, which was replaced with electricity failure. Table 3 Issues encountered by medical students during e-learning Issues faced by students during e-learning Philippines No. (%) (N= 467) Sri Lanka No. (%) (N=184) Poor internet connectivity 297 (63.5) 113 (61.4) Electricity failure 36 (7.7) 110 (59.7) Poor video/sound quality 94 (20.1) 49 (26.6) lack of updated electronic devices 39 (8.3) 19 (10.3) Lack of technical knowledge to join online lectures 4 (0.8) 6 (3.2) High data charges 104 (22.2) 95 (51.6) Lack of preparation by the lecturer 27 (5.7) 28 (15.2) Abbreviations: N, number of participants Readiness for e-learning Almost all the students from both countries showed high computer self-efficacy in terms of using the basic Microsoft functions required for e-learning, use of software and the internet. No difference was observed in readiness for self-directed e-learning between the two countries (Table 4). Table 4 Students’ level of agreement with statements about readiness for continued e-learning Statements on readiness for e-learning Philippines Median (IQR) Sri Lanka Median (IQR) p value Confidence in performing basic functions of Microsoft Office programs (MS Word, MS Excel, and MS PowerPoint) 4 (4-5) 4 (3-4) <0.01 Confidence in knowledge and skills of managing software for e-learning 4 (3-4) 4 (3-4) 0.21 Confidence in using the internet (Google, Yahoo) to find information 4 (4-5) 4 (3.75-5) 0.04 Able to use online tools effectively for communication 3 (3-4) 4 (3-4) 0.55 Seeking assistance when facing learning problems 3 (2-4) 3 (3-4) <0.01 Able to manage time well 3 (3-4) 3 (3-4) 0.52 Able to set own learning goals 3 (3-4) 4 (3-4) 0.30 Able to direct own learning progress 3 (3-4) 4 (3-4) 0.05 Distracted by other online activities during e-learning (instant Messages, internet surfing). 4 (3-4) 3 (3-4) <0.01 Abbreviations: IQR, Inter-quartile range With respect to students’ attitudes toward future learning methods, the Sri Lankan respondents revealed that they are well adapted to online learning. Although the participants from both countries wanted to "continue education through both online and physically/face-to-face", more Filipino respondents expressed a desire for physical face-to-face classes. More than half (55%) of the Sri Lankan respondents had positive perceptions towards continued e-learning, with a median score of 4. In contrast, more than half of the Philippine respondents (53%) were neutral with the median score of 3. Furthermore, in the Philippine group, only one-fourth (23%) had positive overall perceptions of continued e-learning (Table 5). More Sri Lanka respondents (SL= 35% vs. PH= 16%) thought that they were ready to take end-semester exams with pure e-learning. Table 5 Distribution of responses regarding attitudes toward continued e-learning Philippines No. (%) Sri Lanka No. (%) SA/A NS D/SD SA/A NS D/SD Ready to take end-semester exam having had the learning only as e-learning 75 (16.06) 167 (35.76) 225 (48.18) 66 (35.87) 70 (38.89) 48 (26.09) Well adapted to e-learning 146 (21.26) 177 (37.90) 144 (30.84) 96 (52.17) 53 (28.80) 35 (19.02) Thinks to start learning via physical classes 331 (70.88) 106 (22.70) 30 (6.42) 60 (32.61) 75 (40.76) 49 (26.63) Should continue via hybrid format: both online and face-to-face 316 (67.67) 95 (20.34) 56 (11.99) 107 (58.15) 60 (32.61) 17 (9.24) Feels positive toward e-learning 109 (23.34) 249 (53.32) 109 (23.34) 102 (55.43) 58 (31.52) 24 (13.04) Abbreviations: SA, Strongly Agree; A, Agree, NS, Not Sure, D, Disagree; SD, Strongly Disagree In general, the students from Sri Lanka showed a more positive attitude toward continued e-learning (PH: 3 (0.84); SL: 4 (1.00); p<0.05) and felt better adapted to e-learning (PH: 3 (1.03); SL: 4 (1.13); p<0.05). Discussion To understand how students adopted the new normal of the learning environment two years post pandemic, the present study examined students' perceptions and attitudes toward continued e-learning, their preferred learning modalities (purely face-to-face, hybrid, or purely online) and the factors that affected their online learning engagement. The results of this study provide intriguing insights into the different learning modalities experienced and preferred by students in two developing counties of Asia. From an individual and systems standpoint, medical schools and medical students of both countries under study may have been unprepared for a purely online platform at the start of the pandemic and for the transition to hybrid platforms 2–3 years post pandemic. From a pre-pandemic setting where 100% of learning was conducted face-to-face, the radical shift to online learning was aggravated by limited time and digital resources, and the lack of appropriate and adequate support systems for quick acceptance and adjustment may have affected their adaptation to e-learning , [16–21] were found to be prominent issues in the adoption of e-learning during the pandemic in Asia. The high socioeconomic and emotional tension caused by COVID-19 also aggravated the learning situation. Since then, both Filipino and Sri Lankan medical schools have adopted hybrid learning. This might be attributed to the increased preference of administrative and teaching staff for e-learning or logistical challenges in integrating hybrid models [33]. The learner preference for live-synchronous lectures was significantly different between the Philippines and Sri Lanka, with a greater proportion of Sri Lankan students preferring live-synchronous lectures compared with the Filipino students. A greater proportion of Sri Lankan students felt that they could understand content satisfactorily through live-synchronous lectures, suggesting potential disparities in the delivery or quality of online content. Sri Lankan students were more positive about interacting with lecturers through live synchrony and felt more motivated to ask questions than they were in face-to-face settings. Studies indicate that clear communication and structured online lectures improve content comprehension [34]. Mukhtar et al. (2020) reported that the interactive features of online platforms enhance student-instructor communication if effectively utilized [35]. The disparity reported in this study may be due to differences in how interactive tools (e.g., chats, polls) are employed in each region in addition to cultural or educational norms, as well as technological familiarity. Virtual settings have been shown to reduce the social anxiety associated with asking questions [36], but this requires a conducive online environment, which might be better fostered in Sri Lanka. A significant issue in live-synchronous lectures for Filipino students was the lack of peer interaction, which was problematic for only 50% of Sri Lankan students. This suggests that Filipino students may rely more on peer collaboration as part of their learning process or that Sri Lankan universities offer alternative avenues for student interaction. Peer interaction is critical for student engagement and satisfaction in online learning [37–39], and must be considered when implementing educational interventions for the adult learners. Another point of interest is that most students from both countries preferred recorded lectures over live-synchronous lectures, and this preference was marked in Philippine students. This finding contrasts with recent global literature where students have preferred synchronous online classes because they felt that there was more engagement with this platform because it lessened some of the feelings of loneliness [40,41]. However, asynchronous learning environments have shown to allow flexibility in learning, enabling students to review material at their own pace [42], enhancing learner autonomy [43]. Indeed, some studies have shown that students perceive recorded material as more useful than live synchronous lectures [44–46]. Live-synchronous lectures may be more difficult to navigate, especially for more senior faculty members. The importance of teachers’ comfort level and fluency with e-teaching has also contributed to students’ enthusiasm for e-learning [47], which may contribute to the current study findings. The lack of study or working area for doing online activities while at home was one challenge identified by Fabito et al., 2020. Although not directly elicited in this study, this may have affected the study participants’ perceptions regarding live-synchronous learning in this study in both countries. With the use of live-synchronous lectures the possibility that the classmates and tutors would gain a glimpse of their homes would pose an additional stress to students, particularly if they were asked to speak up or switch on the video option when interacting with the others in the class. This will also be an issue if there were several students in the household and if there were no specific study area for each student, as they would be competing for space. Although the students in both regions reported that e-learning was time saving, many Filipino students reported that e-learning was stressful, whereas only a few of Sri Lankan students reported this sentiment. This striking difference may be influenced by cultural coping mechanisms, institutional support, differences in teaching strategies or student autonomy in managing e-learning platforms or technological infrastructure [48–51]. The study revealed that Sri Lankan students were significantly more likely to seek help when encountering difficulties in learning, suggesting stronger help-seeking behavior or better support systems in place within their educational institutions. Students in Sri Lanka presented slightly higher median scores for setting and directing learning goals, reflecting greater preparedness for self-directed learning [52]. On the other hand, Filipino students reported significantly higher levels of distraction from online activities such as instant messaging and internet surfing. The results suggest a greater tendency among Sri Lankan students to take ownership of their learning progress, which may have resulted in greater adaptability to e-learning among Sri Lankan medical students. Interestingly, Filipinos preferred face-to-face lectures over both live-synchronous and recorded lectures. A larger proportion of Filipino students felt that e-learning did not promote active learning, suggesting possible issues with engagement strategies in the Philippines’ e-learning systems. This aligns with research indicating that online environments often struggle to replicate the immersive focus of traditional classrooms due to distractions and technological issues [53,54]. Both countries report poor internet connectivity as the most significant challenge for effective e-learning, affecting more than 60% of the students in each region. This issue is reflective of broader infrastructural limitations, particularly in rural or underserved areas [18,26,55,56]. The preference for recorded lectures among the study participants may be because these may be downloaded and viewed anytime, unlike live-synchronous sessions, which require a reliable internet connection [57]. The study findings reveal that the connectivity issue has not changed in the Sri Lankan landscape since the pandemic [58]. Reliable internet access remains a cornerstone of effective e-learning, and its absence can disrupt live sessions, reduce engagement, and hinder timely completion of tasks. The university administrations have the responsibility to improve the learning environment and cater to students learning needs if they continue to strive for hybrid education post-pandemic. Poor video and sound quality, reported by approximately 20–27% of students in both regions, likely correlates with both internet speed and the quality of devices in both regions. This may be because teachers deliver their lectures in their own homes where the amount of background noise and domestic activity cannot be controlled. A stark contrast is evident in the impact of electricity failure, with Sri Lanka reporting a much higher prevalence than the Philippines does. Sri Lanka's challenges could stem from more frequent power outages or weaker electricity infrastructure. The cost of internet access was found to be significantly greater in Sri Lanka than in the Philippines. High data charges present a major barrier to sustained e-learning engagement, particularly for students from lower-income households [59]. These findings underscore the need for more affordable or subsidized internet services to promote educational equity, highlighting the need for improved digital infrastructure and enhanced multimedia support for online platforms [60]. A positive attitude toward e-learning is dependent on the student’s learning attitude and confidence in independent learning. Students who thrive more in an environment where ideas can be exchanged find social isolation to be a deterrent to learning. On the other hand, students who are not accustomed to studying on their own and are accustomed to being provided with all learning material find e-learning less beneficial.Indeed, students from the two countries showed varying levels of readiness for e-learning, amidst the different levels of adaptation to this learning modality despite continued e-learning albeit in hybrid form for over two years from the pandemic. Although Sri Lankan university students have shown poor adaptation to e-learning closer to the pandemic [13,61], their attitudes have improved according to the findings of the current study. Limitations and recommendations Some limitations to this study need to be acknowledged. The Philippine data was collected from one private accredited medical institution. The findings should be cautiously generalized and interpreted as e-learning conditions may not be the same for students in different institutions within the same country. Furthermore, some aspects of this study depended on participants’ memory, perhaps influencing their reporting, introducing elements of recall bias. The study did not evaluate the ways in which different content may have been taught. Instead, the findings of the present study underscore the multifaceted nature of e-learning readiness and the need for tailored approaches to address regional differences and common challenges. Differences in infrastructure, teaching methods, and cultural factors appear to influence how students perceive and adapt to e-learning. To improve engagement and outcomes, institutions, educators and administrators in both countries might focus on enhancing the student-centered aspects of e-learning, reducing stressors, and tailoring platforms to local needs. The Philippines might particularly benefit from improving engagement strategies in live-synchronous lectures, addressing peer interaction deficits and reducing the perceived stress of the online learning environment. Regular training for instructors and educators in online pedagogy and digital tools can enhance the quality of and engagement in e-learning. Incentives and rewards for the time involved with the development and delivery of online content, improved institutional strategies, support and positive attitudes among all those involved in the development and delivery of online content are recommended [4]. Differences in help-seeking behavior observed in the present study may reflect cultural or institutional norms regarding collaboration and academic support. Based on the data gathered, encouraging proactive help-seeking among medical students from both countries could improve learning outcomes and sustain e-learning in the future. Strategies to minimize online distractions, such as digital well-being programs or app restrictions, could enhance focus and productivity. particularly in the Philippines, where students revealed a higher tendency for distractions and stressors with e-learning. For Sri Lanka, leveraging strong student preferences for online modalities could involve further integrating asynchronous and interactive tools into curricula. Moreover, both countries face significant infrastructure challenges that impede the success of e-learning. Internet connectivity and electricity reliability are critical areas requiring targeted investment and policy interventions. Regional differences, such as the greater prevalence of electricity failure in Sri Lanka, necessitate context-specific strategies. For example, introducing offline content delivery systems or solar-powered alternatives could mitigate electricity-related disruptions. Governments should prioritize expanding broadband access and ensuring stable electricity in underserved areas. High data charges in Sri Lanka highlight the need for collaborative efforts between governments and telecom providers to make internet access more affordable for students. Policies to reduce data charges, such as education-focused subsidies or zero-rated platforms, can alleviate financial barriers. Conclusions This study presents a glimpse of the role of e-learning as a formal teaching/learning approach in medical education two years after the pandemic, with insights for improving online learning in undergraduate medical education and maintaining good practices, especially from the lens of medical students in two Asian countries. The findings provide valuable lessons for better preparation of online education for future doctors. The results revealed that students in the two different countries had different perceptions and psychological behaviors toward e-learning. The study reveals the critical role of students’ e-learning experience in their acceptance of technology in learning about medicine and the need for immersive learning experiences regardless of the pedagogical tools used to deliver education. These findings highlight the need for medical educators and administrators to emphasize the effective use of technology for teaching and learning. Measures should be taken from technological, institutional and individual aspects to improve the learning experience and, hence, the outcomes of online learning. Technological considerations, institutional support to train faculty in instructional design and e-learning and enhancing the social environment and interactions in e-learning platforms could contribute to better development of e-learning in the region. Declarations Ethics approval and consent for participation Ethical approval for this study was obtained from the Ethics Review Committee (ERC), Faculty of Medicine, University of Peradeniya (ID 2022/EC/60) and from the institutional ERC of the University of East-Ramon Magsaysay Memorial Medical Center (approval code: 1554/C/2023/126). Informed consent was obtained from all study participants, and the study was conducted in accordance with the guidelines and regulations of the Declaration of Helsinki. Clinical trial number Not applicable. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon request. Competing interests No potential conflicts of interest were reported by the authors. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors. Authors’ contributions All the authors made substantial contributions to the work. All the authors gave final approval to the submitted paper. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. For individual contributions, the first author (TS) contributed to research conceptualization, research implementation, data collection, analysis, interpretation of results, and writing and revising the manuscript. CMMD contributed to data collection, data analysis, interpretation of the results, and final manuscript writing. KK contributed to the data analysis, interpretation of the results, and writing and revising of the manuscript. JMN contributed to the data collection, interpretation of the results, and final manuscript writing. VMTQ contributed to data collection, interpretation of the results, and writing of the final manuscript. KS contributed to research conceptualization, research implementation, analysis, interpretation of results, and writing of the manuscript. Acknowledgments None. Author’s information ORCIDs of authors: TS: 0000-0002-4311-3668; CMMD: 0009-0003-6796-5309; KK:0000-0003-1546-8100; JMN: 0000-0001-6334-0510; VMTQ: 0009-0005-0827-8204; KS:0000-0002-5562-9426 References Lake R, Dusseault B. School systems make a slow transition from the classroom to the cloud. 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Limitations and Recommendations for online learning during COVID-19 pandemic era. Pak J Med Sci. 2020;36(COVID19–S4):S27. Gillett-Swan J. The challenges of online learning: Supporting and engaging the isolated learner. J Learn Des. 2017;10(1):20–30. Gazit T. For students shall not live by Zoom alone: psychological factors explaining the engagement of students during the COVID-19. Inform Learn Sci. 2024;125(7/8):545–64. Banna J, Lin MFG, Stewart M, Fialkowski MK. Interaction matters: Strategies to promote engaged learning in an online introductory nutrition course. J online Learn teaching/MERLOT. 2015;11(2):249. Adnan M, Anwar K. Online learning amid the COVID19 pandemic. J Pedagogical Sociol Psychol. 2020;2(1):45–51. Kim JW, Myung SJ, Yoon HB, Moon SH, Ryu H, Yim JJ. How medical education survives and evolves during COVID-19: our experience and future direction. PLoS ONE. 2020;15(12):e0243958. Nguyen T, Netto CLM, Wilkins JF, Bröker P, Vargas EE, Sealfon CD, et al. Insights into students’ experiences and perceptions of remote learning methods: From the COVID-19 pandemic to best practice for the future. Frontiers in Education. Frontiers Media SA; 2021. p. 647986. Topale L. The strategic use of lecture recordings to facilitate an active and self-directed learning approach. BMC Med Educ. 2016;16:1–9. Bolliger DU, Martin F. Critical design elements in online courses. Distance Educ. 2021;42(3):352–72. Fatima S, Fatima S, Rafique S, Kanwal S, Rizwan R, Zehra K. Comparison between traditional, recorded, and zoom online physiology teaching in undergraduate medical students during the covid-19 pandemic. Pakistan J Physiol. 2021;17(4):51–4. Aulakh KK, Aneja PS, Saha S, Bansal S. Comparing the Effectiveness of Live Online Lectures vs Recorded Video Lectures as Means of Learning in Medical Education During Covid 19 Lockdowns. Int J Cur Res Rev| Vol. 2021;13(15):65. Huerta CT, Saberi RA, Thorson CM, Hui VW, Rodgers SE, Sands LR. Effects of recorded versus live teleconference didactic lectures on medical student performance in the surgery clerkship. J Surg Educ. 2023;80(2):228–34. Li S, Zhang C, Liu Q, Tong K. E-Learning during COVID-19: perspectives and experiences of the faculty and students. BMC Med Educ. 2022;22(1):328. Cedeño TDD, Rocha ICN, Ramos KG, Uy NMC. Learning strategies and innovations among medical students in the Philippines during the COVID-19 pandemic. Int J Med Students. 2021;9(1):77–9. Mohamed Riyath MI, Muhammed Rijah UL, Rameez A. Students’ attitudes on the use of Zoom in higher educational institutes of Sri Lanka. Asian Association Open Universities J. 2022;17(1):37–52. Adedoyin OB, Soykan E. Covid-19 pandemic and online learning: the challenges and opportunities. Interact Learn Environ. 2023;31(2):863–75. Aguti B, Walters R, Wills G. Effective use of e-learning technologies to promote student-centered learning paradigms within higher education institutions. Int J e-Learning Secur (IJeLS). 2014;1–8. Salih M, Sembawa H, Baradwan S, Nuqali A. Self-directed learning readiness among medical students at Umm Al-Qura University, Saudi Arabia: A cross sectional study. Sch Bull. 2016;2(1):20–6. Abou-Khalil V, Helou S, Khalifé E, Chen MA, Majumdar R, Ogata H. Emergency online learning in low-resource settings: Effective student engagement strategies. Educ Sci (Basel). 2021;11(1):24. Means B, Neisler J. Suddenly online: A national survey of undergraduates during the COVID-19 pandemic. Digital Promise; 2020. Haththotuwa PMPS, Rupasinghe RAHM. Adapting to Online Learning in Higher Education System during the Covid-19 Pandemic: A Case Study of Universities in Sri Lanka. Sri Lanka J Social Sci Humanit. 2021;1(2):147–60. Dost S, Hossain A, Shehab M, Abdelwahed A, Al-Nusair L. Perceptions of medical students towards online teaching during the COVID-19 pandemic: A national cross-sectional survey of 2721 UK medical students. BMJ Open. 2020;10(11). Fabito BS, Trillanes AO, Sarmiento JR. Barriers and challenges of computing students in an online learning environment: Insights from one private university in the Philippines. arXiv preprint arXiv:201202121. 2020. Samarasekara K. e-Learning in Medical Education in Sri Lanka: Survey of Medical Undergraduates and New Graduates. JMIR Med Educ. 2022;8(1). Nafrees ACM, Roshan AMF, Baanu AN, Nihma MNF, Shibly FHA. Awareness of Online Learning of Undergraduates during COVID 19 with special reference to South Eastern University of Sri Lanka. In: Journal of Physics: Conference Series. IOP Publishing Ltd; 2020. Benke M, Widger L. Institutional Infrastructures for Open, Distance, and Digital Education. Handbook of Open, Distance and Digital Education. Springer; 2023. pp. 691–708. Akuratiya DA, Meddage DNR, IJRISS) |Volume V, Issue VII. [Internet]. International Journal of Research and Innovation in Social Science. 2021. Available from: Additional Declarations No competing interests reported. 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Quiñones","email":"","orcid":"","institution":"College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Vinna","middleName":"Marie T.","lastName":"Quiñones","suffix":""},{"id":478156093,"identity":"9bcc7fa5-6601-4264-bdee-8cd76deaddec","order_by":5,"name":"Kosala Somaratne","email":"","orcid":"","institution":"Department of Surgery, District Base Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kosala","middleName":"","lastName":"Somaratne","suffix":""}],"badges":[],"createdAt":"2025-05-15 06:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6669568/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6669568/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85760678,"identity":"bbefc73a-a531-4308-9faa-01290ad24b93","added_by":"auto","created_at":"2025-07-01 11:32:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":941806,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6669568/v1/0809c342-9dd2-4703-955a-46f392a88050.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adaptation to e-learning among medical students: a comparison of two Asian countries","fulltext":[{"header":"Background","content":"\u003cp\u003eIn the wake of the COVID-19 pandemic, medical education has transformed radically to cushion the effects of the pandemic and revamp the education system by switching to e-learning [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While the implementation of e-learning has been deemed a time-intensive and expensive process due to the lack of infrastructure needed [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], medical schools worldwide have implemented e-learning to the benefit of the student fraternity to varying extents and, to a much greater extent, in more recent years since the pandemic [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eE-learning has come to stay, with its merits being investigated widely during the pandemic [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. E-learning has been shown to enhance knowledge gain through easy access to a large amount of information, promoting personal knowledge gain and knowledge sharing within and across groups [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. E-learning has shown to increase learner satisfaction and decrease stress by enabling students to participate in teaching activities while being in their comfort zones [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, while most Asian medical schools relied on traditional teaching methods prior to the pandemic, they have integrated e-learning into medical education to varying degrees [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, medical schools in this part of the world have experienced issues in adopting e-learning similar to the developed world [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A lack of skilled lecturers, social inequalities, a lack of infrastructure [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], high costs of internet data services and poor internet connectivity [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] were found to be prominent issues in the adoption of e-learning during the pandemic in Asia.\u003c/p\u003e \u003cp\u003eA key aftereffect of the pandemic was the continued utilization of online learning platforms for teaching and learning activities. This universal experience highlights the pivotal role of internet infrastructure, digital literacy, and access to devices that enable online education [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Whilst learners adapted to e-learning in the face of the pandemic due to obvious health hazards associated with the traditional classroom, continued e-learning especially in undergraduate medical programmes where e-learning had not taken prominence prior to the pandemic warrants investigating learner perception and readiness for continuing this method of education effectively. Factors such as the perceived usefulness of e-learning, ease of use, pressure to use, good technical skills and the availability of resources needed to use e-learning have impacted students\u0026rsquo; attitudes and readiness toward e-learning [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, the assessment of user characteristics in e-learning systems, especially in South Asian and Southeast Asian regions, appears to be limited [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], despite being a prerequisite for introducing and sustaining successful e-learning systems [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The successful adoption of e-learning systems by learners requires a solid understanding of user acceptance processes with these technologies [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Hence, evaluating perceptions and attitudes becomes vital in analyzing consumer readiness to adopt, as favorable attitudes show a greater probability that learners will willingly accept new learning systems [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Acceptance of the new learning system will be worthwhile as earlier studies reported enhanced knowledge efficiency [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and mean performance of users in favor of online education compared with the same course delivered face to face [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Since users\u0026rsquo; views tend to impact the advancement of e-learning [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], understanding how students perceive and react to elements of e-learning and factors that influence readiness for effective e-learning is essential and timely [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, the differences in context may alter the way the students embrace e-learning, making one plan fit all, a mission impossible.\u003c/p\u003e \u003cp\u003eThe two Asian countries under study, while both being developing countries, show significant contrasts in economic growth and development [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Interestingly, both countries have implemented e-learning to great degrees in higher education institutions at present, driven mostly by the COVID-19 pandemic [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Although the current situation might present a unique opportunity for continuing the modernization of medical education, the attitudes of students toward e-learning post pandemic need to be evaluated to deliver meaningful educational experiences to medical students. Thus, we aimed to describe the medical students\u0026rsquo; attitudes and perceptions for e-learning after the pandemic to determine possible teaching scenarios for future medical education by comparing the responses of a sample of medical students from two different countries in the developing world. We conducted a multicenter study in Asia to provide a broad, scientific basis to guide the future development of e-learning in medical education in this region of the world. The findings of this study could inform academic administrators to adopt e-learning in improving medical education to create mechanisms that can enhance learners\u0026rsquo; attitudes and readiness to adopt e-learning platforms for their education.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy sample and participants\u003c/h2\u003e \u003cp\u003eThe study compared how medical students from the Philippines (PH), a Southeast Asian country, perceived e-learning two years post pandemic as opposed to South Asian (Sri Lankan, SL) medical students. For this purpose, eight state universities with medical schools in Sri Lanka were invited to participate in the study. Similarly, an invitation was sent to medical schools in the Philippines through a locally based coauthor. The inclusion criteria were evidence of transition to e-learning in the medical school with the pandemic and agreement to participate in the online survey. Consent was also obtained from the university administrators. Invitations to each student in their third, fourth or fifth year of study were mediated through the dean\u0026rsquo;s office using each medical school\u0026rsquo;s learning management system (LMS) and group chats (WhatsApp, Messenger, Viber). All the students voluntarily participated in the survey. In SL, the survey was distributed as Google Forms between February and March 2023. In the PH, the data collection was conducted via Google Forms in the month of May 2023.\u003c/p\u003e \u003cp\u003eThe responses were anonymous, but each survey was unique to that study participant and could not be shared or completed more than once. Ethical approval was obtained from the Ethics Review Committee (ERC), Faculty of Medicine, University of Peradeniya (ID: 2022/EC/60) and from the institutional ERC of the University of East-Ramon Magsaysay Memorial Medical Center (approval code: 1554/C/2023/126).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurvey instrument\u003c/h3\u003e\n\u003cp\u003eStudent attitudes and perceptions regarding e-learning were assessed via a questionnaire adapted from Bernard et al. (2004). The items of the study instrument can be categorized into nine main domains. 1) Demographic details (university, study year, gender), 2) e-learning methods (purely online or hybrid: in-person and online), 3) live-synchronous (Zoom/ Google Meet, etc.) and recorded lectures (asynchronous), 4) comparisons between physical or in-person classroom teaching and online teaching, 5) computer/internet self-efficacy, 6) self-directed learning, 7) learner control in an online context (time management), 8) self-motivation for learning in an online context, and 9) online communication self-efficacy [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStatistical data analysis\u003c/h3\u003e\n\u003cp\u003eThe data were exported to Microsoft Excel and promptly cleaned. Descriptive statistics were used to analyze the survey responses. The statistical analysis was performed via SPSS version 22 (IBM, 2014) and Microsoft Excel. First, we tabulated and summarized the demographic characteristics of our study sample. Next, we examined the responses to each measure of e-learning experience. Independent t-test was used to explore the associations between variables. These tests were conducted following the Shapiro‒Wilk normality test, which revealed that the dataset was non-Gaussian in distribution. P values of \u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographic characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree of the eight medical schools in Sri Lanka agreed to participate (n=188). One medical school from the Philippines responded (n=467). We collected data to guarantee their quality in terms of response time and country name. After data cleaning, the sample consisted of six hundred fifty-one (651) medical students from four (4) medical schools representing both countries. A greater proportion of females is observed in undergraduate medical programmes in both countries. Consistently, there was a higher response rate from female medical students in both countries. More responses were received from third-year medical students in both countries. Table 1 shows the participant characteristics of the study sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e Demographic characteristics of the study participants\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8571%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhilippines/PH No. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N= 467)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSri Lanka/SL No. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N= 184)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8571%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e149 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e55 (29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8571%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e318 (68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e129 (70.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear of study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8571%;\"\u003e\n \u003cp\u003e3\u003csup\u003erd\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e127 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e134 (72.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8571%;\"\u003e\n \u003cp\u003e4\u003csup\u003eth\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e315 (67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e17 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.8571%;\"\u003e\n \u003cp\u003e5\u003csup\u003eth\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.4762%;\"\u003e\n \u003cp\u003e25 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5714%;\"\u003e\n \u003cp\u003e33 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation: N, number of participants\u003c/p\u003e\n\u003cp\u003eOverall, students in both regions reported that they experienced the following modes of teaching at specific time periods during and after the pandemic: 1) purely online (PH: 100%; SL: 100%), 2) hybrid (PH: 85.4%, n=399; SL: 100%), and 3) face-to-face (PH: 78.5%, n=367; SL: 100%). All institutions were using a hybrid mode to deliver the education at the time of data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudents\u0026rsquo; perceptions regarding\u0026nbsp;e-learning\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents from both countries valued e-learning because of its time-saving nature (PH: 57%; SL: 79.8%) and the relaxed nature of the learning environment (PH: 55.4%; SL: 62.5%). Although most students from both countries preferred recorded lectures (PH: 63.2%; SL: 52.7%) over live-synchronous lectures, this preference was marked in Filipino students (p=0.01). Medical students from Philippines responded that they understood recorded lectures (PH: 61.9%; SL: 76.7%) better than live-synchronous lectures (PH: 37.7%; SL: 69%). The Sri Lankan medical students felt equally comfortable with both recorded lectures and live-synchronous lectures, with more than half of the students (50% to 69%) agreeing with the following statements regarding live-synchronous lectures: \u0026ldquo;able to understand content clearly\u0026quot;, \u0026quot;interacting with the lecturer is easier than face-to-face lectures\u0026quot;, and \u0026quot;motivated to ask questions than in face-to-face lectures\u0026quot;. For the Philippine respondents, similar proportions, 38% and 39%, respectively, agreed and were neutral to statements \u0026quot;able to understand content clearly\u0026quot;. Furthermore, the Philippine students did not find live-synchronous lectures to provide venue for easier interaction, nor were they more motivated to ask questions when compared with face-to-face lectures. However, in both samples, the majority agree that \u0026quot;lack of peer interaction is a significant issue\u0026quot; (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e Perceptions regarding e-learning, recorded lectures and live-synchronous lectures\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhilippines No. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSri Lanka No. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38.8889%;\" colspan=\"3\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.7143%;\" colspan=\"2\"\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLive-synchronous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003e172 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e87 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eRecorded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003e295 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e97 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhilippines No (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSri Lanka No (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSA/A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD/SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSA/A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD/SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 630px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegarding e-learning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eIs time saving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e265 (57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e80 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e120 (25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e147 (79.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e24 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e13 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eIs student centered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e111 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e161 (34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e195 (41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e112 (60.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e27 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e45 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLearning atmosphere is relaxed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e258 (55.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e96 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e112 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e115 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e19 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eEncourages active learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e141 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e111 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e215 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e75 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e61 (33.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e48 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eEnsures better concentration to learning material\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e80 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e111 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e276 (59.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e91 (49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e48 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e45 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eIs stressful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e293 (62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e105 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e69 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e29 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e54 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e101 (54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 630px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegarding live-synchronous lectures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eAble to understand content clearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e176 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e184 (39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e107 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e127 (69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e41 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eInteracting with the lecturer is easier than face-to-face lectures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e119 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e102 (21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003cp\u003e(52. 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e100 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e48 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e36 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eMotivated to ask questions than in face-to-face lectures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e135 (29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e136 (29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e196 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e101 (54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e59 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e24 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eLack of peer interaction is a significant issue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e352 (75.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e52 (11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e62 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e92 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e51 (27.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e41 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 630px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegarding recorded lectures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eAble to understand content clearly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e289 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e128 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e148 (76.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e31 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003ePreferred over face-to-face lectures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e187 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e112 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e168 (35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e104 (56.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e40 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e40 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: SA, Strongly Agree; A, Agree, NS, Not Sure, D, Disagree; SD, Strongly Disagree\u003c/p\u003e\n\u003cp\u003eThe students in both regions identified significant drawbacks in e-learning. Table 3 presents the issues students encountered during e-learning. The Filipino students stated poor internet connectivity, high data charges, and poor video/sound quality as the top three issues they faced that affected their engagement during e-learning. The same issues were noted among the Sri Lanka students except for poor video and sound quality, which was replaced with electricity failure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Issues encountered by medical students during e-learning\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIssues faced by students during e-learning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.9615%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhilippines No. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N= 467)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.0385%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSri Lanka No. (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=184)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003ePoor internet connectivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.9615%;\"\u003e\n \u003cp\u003e297 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.0385%;\"\u003e\n \u003cp\u003e113 (61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eElectricity failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.9615%;\"\u003e\n \u003cp\u003e36 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.0385%;\"\u003e\n \u003cp\u003e110 (59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003ePoor video/sound quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.9615%;\"\u003e\n \u003cp\u003e94 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.0385%;\"\u003e\n \u003cp\u003e49 (26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003elack of updated electronic devices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.9615%;\"\u003e\n \u003cp\u003e39 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.0385%;\"\u003e\n \u003cp\u003e19 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eLack of technical knowledge to join online lectures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.9615%;\"\u003e\n \u003cp\u003e4 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.0385%;\"\u003e\n \u003cp\u003e6 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eHigh data charges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.9615%;\"\u003e\n \u003cp\u003e104 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.0385%;\"\u003e\n \u003cp\u003e95 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eLack of preparation by the lecturer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.9615%;\"\u003e\n \u003cp\u003e27 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.0385%;\"\u003e\n \u003cp\u003e28 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: N, number of participants \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eReadiness for e-learning\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlmost all the students from both countries showed high computer self-efficacy in terms of using the basic Microsoft functions required for e-learning, use of software and the internet. No difference was observed in readiness for self-directed e-learning between the two countries (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Students\u0026rsquo; level of agreement with statements about readiness for continued e-learning\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatements on readiness for e-learning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhilippines\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSri Lanka\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eConfidence in performing basic functions of Microsoft Office programs (MS Word, MS Excel, and MS PowerPoint)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eConfidence in knowledge and skills of managing software for e-learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eConfidence in using the internet (Google, Yahoo) to find information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (3.75-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eAble to use online tools effectively for communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eSeeking assistance when facing learning problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eAble to manage time well\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eAble to set own learning goals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eAble to direct own learning progress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.4286%;\"\u003e\n \u003cp\u003eDistracted by other online activities during e-learning (instant Messages, internet surfing).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e4 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0952%;\"\u003e\n \u003cp\u003e3 (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: IQR, Inter-quartile range\u003c/p\u003e\n\u003cp\u003eWith respect to students\u0026rsquo; attitudes toward future learning methods, the Sri Lankan respondents revealed that they are well adapted to online learning. Although the participants from both countries wanted to \u0026quot;continue education through both online and physically/face-to-face\u0026quot;, more Filipino respondents expressed a desire for physical face-to-face classes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMore than half (55%) of the Sri Lankan respondents had positive perceptions towards continued e-learning, with a median score of 4. In contrast, more than half of the Philippine respondents (53%) were neutral with the median score of 3. Furthermore, in the Philippine group, only one-fourth (23%) had positive overall perceptions of continued e-learning (Table 5). More Sri Lanka respondents (SL= 35% vs. PH= 16%) thought that they were ready to take end-semester exams with pure e-learning.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003eDistribution of responses regarding attitudes toward continued e-learning\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1111%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 38.8889%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhilippines\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 40%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSri Lanka\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1111%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.127%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSA/A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD/SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSA/A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD/SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1111%;\"\u003e\n \u003cp\u003eReady to take end-semester exam having had the learning only as e-learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.127%;\"\u003e\n \u003cp\u003e75 (16.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e167 (35.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e225 (48.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e66 (35.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e70 (38.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e48 (26.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1111%;\"\u003e\n \u003cp\u003eWell adapted to e-learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.127%;\"\u003e\n \u003cp\u003e146 (21.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e177 (37.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e144 (30.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e96 (52.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e53 (28.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e35 (19.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1111%;\"\u003e\n \u003cp\u003eThinks to start learning via physical classes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.127%;\"\u003e\n \u003cp\u003e331 (70.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e106 (22.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e30 (6.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e60 (32.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e75 (40.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e49 (26.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1111%;\"\u003e\n \u003cp\u003eShould continue via hybrid format: both online and face-to-face\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.127%;\"\u003e\n \u003cp\u003e316 (67.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e95 (20.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e56 (11.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e107 (58.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e60 (32.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e17 (9.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1111%;\"\u003e\n \u003cp\u003eFeels positive toward e-learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.127%;\"\u003e\n \u003cp\u003e109 (23.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e249 (53.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e109 (23.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.3333%;\"\u003e\n \u003cp\u003e102 (55.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.381%;\"\u003e\n \u003cp\u003e58 (31.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2857%;\"\u003e\n \u003cp\u003e24 (13.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: SA, Strongly Agree; A, Agree, NS, Not Sure, D, Disagree; SD, Strongly Disagree\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn general, the students from Sri Lanka showed a more positive attitude toward continued e-learning (PH: 3 (0.84); SL: 4 (1.00); p\u0026lt;0.05) and felt better adapted to e-learning (PH: 3 (1.03); SL: 4 (1.13); p\u0026lt;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo understand how students adopted the new normal of the learning environment two years post pandemic, the present study examined students' perceptions and attitudes toward continued e-learning, their preferred learning modalities (purely face-to-face, hybrid, or purely online) and the factors that affected their online learning engagement. The results of this study provide intriguing insights into the different learning modalities experienced and preferred by students in two developing counties of Asia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom an individual and systems standpoint, medical schools and medical students of both countries under study may have been unprepared for a purely online platform at the start of the pandemic and for the transition to hybrid platforms 2–3 years post pandemic. From a pre-pandemic setting where 100% of learning was conducted face-to-face, the radical shift to online learning was aggravated by limited time and digital resources, and the lack of appropriate and adequate support systems for quick acceptance and adjustment may have affected their adaptation to e-learning , [16–21] were found to be prominent issues in the adoption of e-learning during the pandemic in Asia. The high socioeconomic and emotional tension caused by COVID-19 also aggravated the learning situation. Since then, both Filipino and Sri Lankan medical schools have adopted hybrid learning. This might be attributed to the increased preference of administrative and teaching staff for e-learning or logistical challenges in integrating hybrid models [33].\u003c/p\u003e\n\u003cp\u003eThe learner preference for live-synchronous lectures was significantly different between the Philippines and Sri Lanka, with a greater proportion of Sri Lankan students preferring live-synchronous lectures compared with the Filipino students. A greater proportion of Sri Lankan students felt that they could understand content satisfactorily through live-synchronous lectures, suggesting potential disparities in the delivery or quality of online content. Sri Lankan students were more positive about interacting with lecturers through live synchrony and felt more motivated to ask questions than they were in face-to-face settings. Studies indicate that clear communication and structured online lectures improve content comprehension [34]. Mukhtar et al. (2020) reported that the interactive features of online platforms enhance student-instructor communication if effectively utilized [35]. The disparity reported in this study may be due to differences in how interactive tools (e.g., chats, polls) are employed in each region in addition to cultural or educational norms, as well as technological familiarity. Virtual settings have been shown to reduce the social anxiety associated with asking questions [36], but this requires a conducive online environment, which might be better fostered in Sri Lanka.\u003c/p\u003e\n\u003cp\u003eA significant issue in live-synchronous lectures for Filipino students was the lack of peer interaction, which was problematic for only 50% of Sri Lankan students. This suggests that Filipino students may rely more on peer collaboration as part of their learning process or that Sri Lankan universities offer alternative avenues for student interaction. Peer interaction is critical for student engagement and satisfaction in online learning [37–39], and must be considered when implementing educational interventions for the adult learners.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother point of interest is that most students from both countries preferred recorded lectures over live-synchronous lectures, and this preference was marked in Philippine students. This finding contrasts with recent global literature where students have preferred synchronous online classes because they felt that there was more engagement with this platform because it lessened some of the feelings of loneliness [40,41]. However, asynchronous learning environments have shown to allow flexibility in learning, enabling students to review material at their own pace [42], enhancing learner autonomy [43]. Indeed, some studies have shown that students perceive recorded material as more useful than live synchronous lectures\u0026nbsp;[44–46]. Live-synchronous lectures\u0026nbsp;may be more difficult to navigate, especially for more senior faculty members. The importance of\u0026nbsp;teachers’ comfort level and fluency with e-teaching has also contributed to students’ enthusiasm\u0026nbsp;for\u0026nbsp;e-learning [47], which may contribute to the current study findings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe lack of study or working area for doing online activities while at home was one challenge identified by Fabito \u003cem\u003eet al.,\u003c/em\u003e 2020. \u0026nbsp;Although not directly elicited in this study, this may have affected the study participants’ perceptions regarding live-synchronous learning in this study in both countries. With the use of live-synchronous lectures the possibility that the classmates and tutors would gain a glimpse of their homes would pose an additional stress to students, particularly if they were asked to speak up or switch on the video option when interacting with the others in the class. This will also be an issue if there were several students in the household and if there were no specific study area for each student, as they would be competing for space.\u003c/p\u003e\n\u003cp\u003eAlthough the students in both regions reported that e-learning was time saving, many Filipino students reported that e-learning was stressful, whereas only a few of Sri Lankan students reported this sentiment. This striking difference may be influenced by cultural coping mechanisms, institutional support, differences in teaching strategies or student autonomy in managing e-learning platforms or technological infrastructure\u0026nbsp;[48–51]. The study\u0026nbsp;revealed\u0026nbsp;that Sri Lankan students were significantly more likely to seek help when encountering difficulties in learning, suggesting stronger help-seeking behavior or better support systems in place within their educational institutions. Students in Sri Lanka\u0026nbsp;presented\u0026nbsp;slightly higher median scores for setting and directing learning goals, reflecting\u0026nbsp;greater\u0026nbsp;preparedness for self-directed learning [52]. On the other hand, Filipino students reported significantly higher levels of distraction from online activities such as instant messaging and internet surfing. The results suggest a greater tendency among Sri Lankan students to take ownership of their learning progress, which may have resulted in\u0026nbsp;greater\u0026nbsp;adaptability to e-learning among Sri Lankan medical students.\u003c/p\u003e\n\u003cp\u003eInterestingly, Filipinos preferred face-to-face lectures over both live-synchronous and recorded lectures. A larger proportion of Filipino students felt that e-learning did not promote active learning, suggesting possible issues with engagement strategies in the Philippines’ e-learning systems. This aligns with research indicating that online environments often struggle to replicate the immersive focus of traditional classrooms due to distractions and technological issues\u0026nbsp;[53,54].\u003c/p\u003e\n\u003cp\u003eBoth countries report poor internet connectivity as the most significant challenge for effective e-learning, affecting more than 60% of the students in each region. This issue is reflective of broader infrastructural limitations, particularly in rural or underserved areas [18,26,55,56]. The preference for recorded lectures among the study participants may be because these may be downloaded and viewed anytime, unlike live-synchronous sessions, which require a reliable internet connection \u0026nbsp;[57]. The study findings reveal that the connectivity issue has not changed in the Sri Lankan landscape since the pandemic [58]. Reliable internet access remains a cornerstone of effective e-learning, and its absence can disrupt live sessions, reduce engagement, and hinder timely completion of tasks. The university administrations have the responsibility to improve the learning environment and cater to students learning needs if they continue to strive for hybrid education post-pandemic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePoor video and sound quality, reported by approximately 20–27% of students in both regions, likely correlates with both internet speed and the quality of devices in both regions. This may be because teachers deliver their lectures in their own homes where the amount of background noise and domestic activity cannot be controlled.\u0026nbsp;A stark contrast is evident in the impact of electricity failure, with Sri Lanka reporting a much higher prevalence than the Philippines does. Sri Lanka's challenges could stem from more frequent power outages or weaker electricity infrastructure. The cost of internet access was found to be significantly greater in Sri Lanka than in the Philippines. High data charges present a major barrier to sustained e-learning engagement, particularly for students from lower-income households [59]. These findings underscore the need for more affordable or subsidized internet services to promote educational equity, highlighting the need for improved digital infrastructure and enhanced multimedia support for online platforms [60].\u003c/p\u003e\n\u003cp\u003eA positive attitude toward e-learning is dependent on the student’s learning attitude and\u0026nbsp;confidence in independent learning.\u0026nbsp;Students\u0026nbsp;who thrive more in an environment where ideas can be exchanged find social isolation to be a deterrent to learning. On\u0026nbsp;the\u0026nbsp;other hand, students who are not\u0026nbsp;accustomed\u0026nbsp;to studying on their own and are accustomed to being provided with all learning\u0026nbsp;material find e-learning less beneficial.Indeed, students from the two countries showed varying levels of readiness for e-learning, amidst the different levels of adaptation to this learning modality despite continued e-learning albeit in hybrid form for over two years from the pandemic. Although Sri Lankan university students have shown poor adaptation to e-learning closer to the pandemic [13,61], their attitudes have improved according to the findings of the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome limitations to this study need to be acknowledged. The Philippine data was collected from one private accredited medical institution. The findings should be cautiously generalized and interpreted as e-learning conditions may not be the same for students in different institutions within the same country. Furthermore, some aspects of this study depended on participants’ memory, perhaps influencing their reporting, introducing elements of recall bias. The study did not evaluate the ways in which different content may have been taught.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInstead, the findings of the present study underscore the multifaceted nature of e-learning readiness and the need for tailored approaches to address regional differences and common challenges. Differences in infrastructure, teaching methods, and cultural factors appear to influence how students perceive and adapt to e-learning. To improve engagement and outcomes, institutions, educators and administrators in both countries might focus on enhancing the student-centered aspects of e-learning, reducing stressors, and tailoring platforms to local needs. The Philippines might particularly benefit from improving engagement strategies in live-synchronous lectures, addressing peer interaction deficits and reducing the perceived stress of the online learning environment. Regular training for instructors and educators in online pedagogy and digital tools can enhance the quality of and engagement in e-learning. Incentives and rewards for the time involved with the development and delivery of online content, improved institutional strategies, support and positive attitudes among all those involved in the development and delivery of online content are recommended\u0026nbsp;[4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDifferences in help-seeking behavior observed in the present study may reflect cultural or institutional norms regarding collaboration and academic support. Based on the data gathered, encouraging proactive help-seeking among medical students from both countries could improve learning outcomes and sustain e-learning in the future. Strategies to minimize online distractions, such as digital well-being programs or app restrictions, could enhance focus and productivity. particularly in the Philippines, where students revealed a higher tendency for distractions and stressors with e-learning.\u003c/p\u003e\n\u003cp\u003eFor Sri Lanka, leveraging strong student preferences for online modalities could involve further integrating asynchronous and interactive tools into curricula. Moreover, both countries face significant infrastructure challenges that impede the success of e-learning. Internet connectivity and electricity reliability are critical areas requiring targeted investment and policy interventions. Regional differences, such as the greater prevalence of electricity failure in Sri Lanka, necessitate context-specific strategies. For example, introducing offline content delivery systems or solar-powered alternatives could mitigate electricity-related disruptions. Governments should prioritize expanding broadband access and ensuring stable electricity in underserved areas. High data charges in Sri Lanka highlight the need for collaborative efforts between governments and telecom providers to make internet access more affordable for students. Policies to reduce data charges, such as education-focused subsidies or zero-rated platforms, can alleviate financial barriers.\u003c/p\u003e\n\n"},{"header":"Conclusions","content":"\u003cp\u003eThis study presents a glimpse of the role of e-learning as a formal teaching/learning approach in medical education two years after the pandemic, with insights for improving online learning in undergraduate medical education and maintaining good practices, especially from the lens of medical students in two Asian countries. The findings provide valuable lessons for better preparation of online education for future doctors. The results revealed that students in the two different countries had different perceptions and psychological behaviors toward e-learning. The study reveals the critical role of students’ e-learning experience in their acceptance of technology in learning about medicine and the need for immersive learning experiences regardless of the pedagogical tools used to deliver education. These findings highlight the need for medical educators and administrators to emphasize the effective use of technology for teaching and learning. Measures should be taken from technological, institutional and individual aspects to improve the learning experience and, hence, the outcomes of online learning. Technological considerations, institutional support to train faculty in instructional design and e-learning and enhancing the social environment and interactions in e-learning platforms could contribute to better development of e-learning in the region.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent for participation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Ethics Review Committee (ERC), Faculty of Medicine, University of Peradeniya (ID 2022/EC/60) and from the institutional ERC of the University of East-Ramon Magsaysay Memorial Medical Center (approval code: 1554/C/2023/126). Informed consent was obtained from all study participants, and the study was conducted in accordance with the guidelines and regulations of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflicts of interest were reported by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors made substantial contributions to the work. All the authors gave final approval to the submitted paper. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. For individual contributions, the first author (TS) contributed to research conceptualization, research implementation, data collection, analysis, interpretation of results, and writing and revising the manuscript. CMMD contributed to data collection, data analysis, interpretation of the results, and final manuscript writing. KK contributed to the data analysis, interpretation of the results, and writing and revising of the manuscript. JMN contributed to the data collection,\u0026nbsp;interpretation of the results, and final manuscript writing. VMTQ contributed to data collection,\u0026nbsp;interpretation of the results, and writing of the final manuscript. KS contributed to research conceptualization, research implementation, analysis, interpretation of results, and writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eORCIDs of authors: TS: 0000-0002-4311-3668; CMMD: 0009-0003-6796-5309; KK:0000-0003-1546-8100; JMN: 0000-0001-6334-0510; VMTQ: 0009-0005-0827-8204; KS:0000-0002-5562-9426\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLake R, Dusseault B. School systems make a slow transition from the classroom to the cloud. 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Sch Bull. 2016;2(1):20\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbou-Khalil V, Helou S, Khalif\u0026eacute; E, Chen MA, Majumdar R, Ogata H. Emergency online learning in low-resource settings: Effective student engagement strategies. Educ Sci (Basel). 2021;11(1):24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeans B, Neisler J. Suddenly online: A national survey of undergraduates during the COVID-19 pandemic. Digital Promise; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaththotuwa PMPS, Rupasinghe RAHM. Adapting to Online Learning in Higher Education System during the Covid-19 Pandemic: A Case Study of Universities in Sri Lanka. Sri Lanka J Social Sci Humanit. 2021;1(2):147\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDost S, Hossain A, Shehab M, Abdelwahed A, Al-Nusair L. Perceptions of medical students towards online teaching during the COVID-19 pandemic: A national cross-sectional survey of 2721 UK medical students. BMJ Open. 2020;10(11).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFabito BS, Trillanes AO, Sarmiento JR. Barriers and challenges of computing students in an online learning environment: Insights from one private university in the Philippines. arXiv preprint arXiv:201202121. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamarasekara K. e-Learning in Medical Education in Sri Lanka: Survey of Medical Undergraduates and New Graduates. JMIR Med Educ. 2022;8(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNafrees ACM, Roshan AMF, Baanu AN, Nihma MNF, Shibly FHA. Awareness of Online Learning of Undergraduates during COVID 19 with special reference to South Eastern University of Sri Lanka. In: Journal of Physics: Conference Series. IOP Publishing Ltd; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenke M, Widger L. Institutional Infrastructures for Open, Distance, and Digital Education. Handbook of Open, Distance and Digital Education. Springer; 2023. pp. 691\u0026ndash;708.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkuratiya DA, Meddage DNR, IJRISS) |Volume V, Issue VII. [Internet]. International Journal of Research and Innovation in Social Science. 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.rsisinternational.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"e-learning, medical students, perceptions, attitudes, readiness","lastPublishedDoi":"10.21203/rs.3.rs-6669568/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6669568/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDue to the COVID-19 pandemic, universities have shifted to offeringe-learning for their students from traditional face-to-face learning, which continues to varying degrees to date. With the current trend for hybrid learning, learner perceptions and factors contributing to effective e-learning need to be identified to improve the student learning experience in medical schools. The present study aimed to describe medical students’ perceptions ofand readiness for e-learning after the pandemic. The insights gained will enable educators to create mechanisms that can enhance learners’ attitudes and readiness for adopting e-learning platforms for their education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA self-administered online survey with medical students in the third, fourth and fifth yearsof study in two countries,the Philippines (PH) and Sri Lanka (SL), was conducted. Six hundred fifty-one (651) medical students across four medical schools responded. Descriptive statistics were used to analyze the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eStudents from both countries valued e-learning for its time-saving nature (PH: 57%; SL: 79.8%) and relaxed nature of the learning environment (PH: 55.4%; SL: 62.5%). Students from both countries preferred recorded lectures (PH: 63.2%; SL: 52.7%) over live-synchronous lectures. Although students from both countries demonstrated high levels of readiness for self-directed e-learning, Philippine medical students preferred face-to-face lectures over live synchronous or recorded lectures (PH: 295, 63.2%; SL: 97, 52.7%; p\u0026lt;0.01). Filipinos felt that e-learning was more stressful (PH: 293, 62.8%; SL: 29, 15.8%; p\u0026lt;0.001). Most students from both regions faced connectivity issues (PH: 63.5%; SL: 61.4%). Overall, SL medical students reported a more positive attitude toward e-learning (median score: PH: 3 (0.84); SL: 4 (1.00); p\u0026lt;0.05) and felt better adapted to e-learning (PH: 3 (1.03); SL: 4 (1.13); p\u0026lt;0.05) than their Filipino counterparts did.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe results revealed that students in the two different countries under study had different perceptions and psychological behaviors toward e-learning despite demonstrating high computer self-efficacy. The study reveals the need for immersive learning experiences regardless of the pedagogical tools used to deliver medical education. The challenges medical students facein engaging in e-learning imply the need for medical educators and administrators to emphasize the effective use of technology for teaching and learning.\u003c/p\u003e","manuscriptTitle":"Adaptation to e-learning among medical students: a comparison of two Asian countries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 11:24:27","doi":"10.21203/rs.3.rs-6669568/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-20T06:36:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218079009752914763867747812476517449218","date":"2026-05-11T14:36:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152308395181650033280378736835183650115","date":"2026-05-11T11:57:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-16T04:35:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115108626155342472434510785497222633803","date":"2025-06-30T04:49:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-27T14:20:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-05T05:57:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-21T07:55:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-20T04:39:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-05-20T04:38:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9604ad3a-a59d-4fd1-8e15-49491dd330be","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-20T06:36:25+00:00","index":94,"fulltext":""},{"type":"reviewerAgreed","content":"218079009752914763867747812476517449218","date":"2026-05-11T14:36:17+00:00","index":92,"fulltext":""},{"type":"reviewerAgreed","content":"152308395181650033280378736835183650115","date":"2026-05-11T11:57:53+00:00","index":90,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-01T11:24:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-01 11:24:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6669568","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6669568","identity":"rs-6669568","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}