Survey of Students' Views on Online Exams at Medical Universities in Iran During the COVID-19 Outbreak

Survey of Students' Views on Online Exams at Medical Universities in Iran During the COVID-19 Outbreak | 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 Article Survey of Students' Views on Online Exams at Medical Universities in Iran During the COVID-19 Outbreak Sadegh Sharafi, Hosna Salmani, Hossein Valizadeh laktarashi, Zeynab Naseri, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6116030/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract During the COVID-19 pandemic, medical universities in Iran have changed from traditional exams to online exams for their educational practices. This research explores medical students' opinions on online exams during this shift, seeking to assess their contentment and the elements affecting their interactions. A descriptive survey was accomplished by distributing a structured questionnaire to 1,517 medical students in different universities in Iran. The study gathered information on demographics and evaluated students' contentment with online exams through a five-point Likert scale. Data analysis included both descriptive and inferential statistics, including exploratory and confirmatory factor analyses. 63.3% of the participants were women. The results showed student satisfaction ratings differed by category, with technical assistance having the lowest average score of 2.48 and general satisfaction at 3.11. Strong connections were found between satisfaction and elements like exam content, technical support, and instructor performance. The shift to digital assessments has brought to light both possibilities and obstacles for medical education in Iran. Although online exams have the potential to decrease student anxiety and enhance contentment, there is a need for substantial enhancements in technical resources and assistance. This research provides valuable information that can help improve online assessment methods, leading to better virtual learning settings. Earth and environmental sciences/Environmental social sciences Earth and environmental sciences/Environmental social sciences/Environmental impact COVID-19 online exams medical education student satisfaction e-learning Iran Figures Figure 1 Introduction The COVID-19 pandemic changed education systems all over the world, and higher education institutions had to adjust to remote learning and assessment ( 1 ). Medical universities had it tougher, given the high stakes of medical education and the practical skills required for training healthcare professionals ( 2 ). In Iran like many other countries, the pandemic forced us to switch from traditional in-person exams to online assessments and this raised questions about the effectiveness, reliability, and fairness of such methods in high-stakes environments ( 3 ). Online exams with the help of technological tools emerged as a solution to continue education during lockdowns, But this was not without its challenges ( 4 ). Medical students have unique pressures due to the intensity of their training ( 5 ). For many online exams were an unfamiliar format, with issues related to accessibility, technological readiness, and academic integrity ( 6 ). These factors could affect not only students’ performance but also their perception of the whole examination process ( 6 , 7 ). The global health crisis called the pandemic which started in late 2019 is recognized by World Health Organization with a daily increase in the number of cases ( 8 ). In the beginning of 2020 when the pandemic started 1.5 billion students globally lost the opportunity to attend face-to-face classes and exams ( 9 ). The pandemic presented risks and opportunities for universities and academic circles and we learned valuable lessons in online learning and getting ready for a new phase of creative teaching approaches. The COVID-19 outbreak in Iran during the second semester of the 98–99 academic year forced us to implement electronic systems and online education to protect students ( 9 ). Distance education emerged as a practical solution for these challenges ( 10 ). Pandemic and geographical adjustment. The pandemic and geographical adjustment accelerated online education and digital platforms in the education sector. The rise in online education during the pandemic has provided students with the flexibility and accessibility to better handle their academic and personal duties. Nevertheless, the sudden shift posed notable difficulties, especially in Iran, as the digital education system was still evolving. Previous studies have focused on different elements of online education and evaluation. For example, Ranjdoost, et al (2019) discovered that virtual exams can greatly decrease student anxiety, highlighting the importance of a strong online exam system. Likewise, Ganji, et al (2017) showed a clear connection between online assessment quality and student contentment, highlighting the importance of enhancing exam quality for improving student experiences. A global survey by Coman et al. exposure to, found that technical difficulties, inadequate infrastructure, and isolation were barriers for students learning remotely during the pandemic which in turn made satisfying experience with written examinations online ( 11 ). In addition, a study on medical students found they felt that online examinations are not fair due to concerns about cheating and the inability to replicate traditional exam atmosphere ( 12 ). Specifically in Iran's context, where the educational infrastructures are quite different from urban to rural, those challenges might be more significant. Online exams also came with some benefits. For example, online assessments provided the flexibility and continuity of academic timetables that were needed internationally during a time of global uncertainty ( 13 ). Furthermore, online assessments promote more innovative methods of evaluation like open-book exams and problem-based assessment, which some educators feel assess critical thinking skills more effectively than traditional formats ( 14 ). Unfortunately, gaining these benefits did not come without ensuring all students received a positive experience. Issues such as the nonavailability of the internet, lack of uniformity in exam monitoring, and increased anxiety due to newer surroundings had particular mention in concerns raised by medical students ( 15 ). Additionally, the pandemic highlighted and widened existing disparities in access to technology due to the background status of students ( 16 ), causing a digital divide between lower classes and remote areas. Here's something very relevant, especially for Iran, where the competition to enter medicine is intense ( 17 ). The perception of students about the transition towards online examination is important because it feeds back to universities, who can then work on mitigating these imperfections and giving place for refining future assessment strategies ( 18 ). Those insights can help inform policies that must be equitable yet effective in crisis situations ( 19 ). This study aims to provide a comprehensive review of the views of medical students on online exams in Iran during the COVID-19 pandemic. It calls into question their experiences, what they faced challenges with, and how this benefitted them in terms of perceptions detailed findings on how these experiences affected the perception of online assessments. Through these perspectives, the study seeks both to add to the emerging medical education literature about online post-COVID-19 and to provide insights relevant to policy-makers and educators. The results of this survey will contribute to designing future examination systems and provide useful insights for better integration of technology in medical education. The world is still coming to terms with how most of these pandemics unfolded, and we must take all of this information into consideration in order to form a more sustainable education system for the future. Methods This descriptive study utilized a questionnaire to collect data from students in medical universities across Iran. The survey was structured in two parts: demographic information (age, gender, education level, etc.) and core questions aimed at measuring student satisfaction with online exams. Responses were rated on a five-point Likert scale, where 1 indicated low satisfaction and 5 indicated high satisfaction. To ensure the validity and reliability of the questionnaire, it was reviewed by experts in virtual education. A pilot test was conducted with 10 participants to assess the clarity and functionality of the survey. The finalized questionnaire was then distributed electronically to the sample population. Study Hypotheses The study investigated several hypotheses: There is a significant relationship between demographic factors and students' satisfaction with the online exam system. Students' interest in virtual education is positively correlated with their views on online exams. Students' expectations for effective learning influence their satisfaction with online assessments. The reliability of technology used in online exams affects students' perceptions of the system. The method of course delivery impacts students' satisfaction with online exams. Interaction between students and faculty members plays a role in shaping students' views on online assessments. Exploratory Factor Analysis (EFA) The EFA results indicated a Kaiser-Meyer-Olkin (KMO) measure of 0.937, and Bartlett's test was significant (χ²(df = 171) = 17898.97, p < 0.001). Certain components, such as "How do you evaluate the performance of the Education Office in timely notification of online exams?" and "How do you evaluate the technical support unit's services in addressing technical issues?" showed cross-loadings and were subsequently excluded from further analysis. The remaining 19-component tool explained 73.42% of the total variance across five factors. Confirmatory Factor Analysis (CFA) The CFA assessed the model fit for the proposed 5-factor; 19-component structure identified in the EFA. The reliability and validity of the model were confirmed. The Composite Reliability (CR) for all factors exceeded 0.7, and the Average Variance Extracted (AVE) for all factors surpassed 0.5, supporting the tool's reliability. Additionally, the AVE for all factors was greater than the Maximum Shared Variance (MSV), and the square root of the AVE for each factor was higher than the pairwise correlation coefficients between factors. Goodness-of-fit indices indicated an acceptable model fit: CFI = 0.965, TLI = 0.958, RMSEA = 0.054 (95% CI: 0.05–0.057), PCLOSE = 0.052, and SRMR = 0.044. (See Table 1 ) Table 1 Summary of Reliability and Validity Indices Factor CR AVE MSV Education Office 0.900 0.602 0.481 Exam Content 0.882 0.655 0.550 Student Satisfaction 0.817 0.534 0.376 Instructor Performance 0.876 0.702 0.550 Technical Unit 0.857 0.667 0.481 Sample Size and Data Collection The target population consisted of students from medical universities in Iran. Given that no similar studies have been conducted, a sample size of 1066 was determined using the formula for estimating proportions of a qualitative attribute, with Z = 1.96, P = 0.5, and d = 0.03. A stratified random sampling method was employed to ensure representation from all 64 medical universities. A total of 355 questionnaires were allocated to each type of university based on their student populations, and data collection continued until this number was reached for each type. Inclusion and Exclusion Criteria Inclusion criteria for the study comprised: Voluntary and informed consent Enrollment in a medical university in Iran Completion of at least four online exams Familiarity with online education systems. Exclusion criteria included failure to complete the questionnaire. Data Analysis Data were analysed using SPSS version 21, employing both descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential statistics (independent t-tests, one-way ANOVA, chi-square tests, and correlation analyses). Results The study involved 1,517 students from medical universities across the country, of which 63.3% (960 students) were female. The majority of participants were between 20 to 25 years old, as shown in Table 2. Table 2. Demographics of Participants Variable Categories Number Percentage Gender Male 557 36.7% Female 960 63.3% Age Group Below 20 207 13.6% 20-25 1,166 76.9% 26-30 90 5.9% 31-35 19 1.3% 36-40 18 1.2% 41-45 12 0.8% 46-50 5 0.3% Educational Level Associate Degree 45 3.0% Bachelor's Degree 1,041 68.6% Master's Degree 83 5.5% PhD 348 22.9% The descriptive statistics for the five key components—education, technical support, content, performance, and satisfaction—are summarized in the following table. Among the components, technical support received the lowest mean score (2.48), and student satisfaction had the highest mean score (3.11). When comparing the mean scores of educations, technical support, and performance with satisfaction, the mean scores of educations, technical support, and performance were significantly lower (p < 0.05) than the satisfaction score (See Table 3). Table 3. Mean Scores for the Five Components Component Minimum Maximum Mean Std. Deviation p-value Education 1 5 2.78 0.88 <0.001 Technical 1 5 2.48 0.85 <0.001 Content 1 5 3.07 0.98 0.17 Performance 1 5 2.93 1.03 <0.001 Satisfaction 1 5 3.11 1.01 Baseline In terms of gender, male students scored higher than female students in the performance and satisfaction components. For the age groups, students aged 20-25 had the highest mean scores in content, performance, and satisfaction, while those over 30 had the lowest (p < 0.05). Similarly, for the technical component, students in the age groups of 20-25 and 26-30 had the highest scores, while students under 20 scored the lowest (p < 0.05) (See Table 4). Table 4. Comparison of Mean Scores by Gender and Age Group Group Education (Mean ± SD) p-value Technical (Mean ± SD) p-value Content (Mean ± SD) p-value Performance (Mean ± SD) p-value Satisfaction (Mean ± SD) p-value Male 2.81 ± 0.88 0.54 2.47 ± 0.85 0.42 3.05 ± 0.98 0.49 3.01 ± 1.09 0.038 3.18 ± 1.05 0.02 Female 2.76 ± 0.87 2.49 ± 0.84 3.08 ± 0.97 2.88 ± 0.99 3.06 ± 0.99 Below 20 2.68 ± 0.92 0.31 2.34 ± 0.84 0.038 2.91 ± 1.01 0.016 2.77 ± 1.1 0.004 2.84 ± 1.02 <0.001 20-25 2.8 ± 0.86 2.51 ± 0.85 3.11 ± 0.97 2.97 ± 1.0 3.17 ± 1.0 26-30 2.73 ± 0.73 2.51 ± 0.82 3 ± 0.91 2.96 ± 1.02 3.15 ± 1.01 Over 30 2.67 ± 1.16 2.47 ± 0.92 2.85 ± 0.99 2.52 ± 1.20 2.68 ± 1.12 Furthermore, a comparison of students at different educational levels showed that PhD students scored the highest in education, content, performance, and satisfaction, while Master’s students had the lowest mean scores (p < 0.05). For the technical component, Bachelor's students had the highest scores, and Master’s students had the lowest (p < 0.05) (See Table 5). Table 5. Comparison of Mean Scores by Educational Level Educational Level Education (Mean ± SD) p-value Technical (Mean ± SD) p-value Content (Mean ± SD) p-value Performance (Mean ± SD) p-value Satisfaction (Mean ± SD) p-value Associate 2.71 ± 0.97 0.017 2.41 ± 0.94 0.03 2.84 ± 1.03 0.002 2.75 ± 1.08 <0.001 3.09 ± 0.99 0.003 Bachelor’s 2.77 ± 0.88 2.51 ± 0.84 3.06 ± 0.98 2.86 ± 1.01 3.07 ± 1.02 Master’s 2.53 ± 0.96 2.29 ± 0.84 2.78 ± 0.89 2.57 ± 1.05 2.90 ± 0.92 PhD 2.85 ± 0.83 2.46 ± 0.85 3.18 ± 0.94 3.23 ± 1.0 3.27 ± 1.01 Correlation Analysis According to Figure 1, strong correlations were observed between student satisfaction with exam content, the performance of the education administration, the technical unit, and professors. The analysis revealed that professors’ performance had the greatest impact on overall student satisfaction with online exams. Satisfaction with the educational administration and the technical unit played a similar role in determining overall satisfaction, but exam content did not significantly impact overall satisfaction. Collectively, these four components accounted for 51% of the variance in student satisfaction, leaving 49% unexplained. Discussion The use of digital tools in education has significantly changed the way universities carry out assessments. This article combines results from studies in Iran and abroad to examine how electronic assessments impact student experiences, highlighting both similarities and differences with our own research results. In their 2018 study, Ranjdoust and colleagues investigated how virtual exams can help reduce stress among students and staff at Payame Noor University. Their results showed a notable decrease in stress-related symptoms like anxiety and emotional distress with the introduction of virtual assessments ( 20 ). This is consistent with what we found in our research, as medical students also mentioned feeling that online exams have the ability to reduce stress. Both studies indicate the importance of enhancing the virtual assessment infrastructure to create a supportive testing environment. On the other hand, Arjenaki and colleagues (2017) investigated how assessment quality is related to student satisfaction, finding a positive connection indicating that improvements in e-assessment quality can greatly increase student satisfaction ( 21 ). Although our results show a strong connection between students' satisfaction and the perceived quality of online assessments, the level of predictability (21%) highlighted by Arjenaki implies that assessment quality has a more significant impact than we initially thought. This difference highlights the necessity for more research on the particular aspects of quality that have the greatest effect on student satisfaction in different educational settings. Despite significant progress, obstacles persist in the implementation of electronic testing in Iran, as pointed out by Habibi et al. (2016). These challenges include technical issues and worries about content delivery and security ( 22 ). Our study confirms these findings by demonstrating that many students experienced similar challenges, particularly with regards to digital skills and the reliability of the technology used for virtual assessments. This common agreement underscores the pressing requirement for holistic approaches to address these issues and improve the overall efficiency of electronic assessments. Costa et al. (2016) conducted a global assessment on the implementation of virtual learning platforms in nursing education, finding that a large majority of students showed a preference for using virtual tools to enhance their skill acquisition ( 23 ). This corresponds to what we discovered, as medical students exhibited a favorable attitude toward the flexibility provided by online exams. Costa et al.'s study highlighting the link between virtual learning and increased motivation is consistent with our findings of boosted engagement in online evaluations. Stowell and Lamshed (2011) indicated recommendations for improving electronic assessments, emphasizing the importance of strong infrastructure and technical standards ( 24 ). Our research strengthens this suggestion, promoting continuous investments in technological advancements to facilitate the successful execution of online evaluations. In the same manner, Allen and Seaman (2010) showed that electronic assessments are capable of assessing a wide variety of skills, which is in line with our discovery that online exams can contribute to a more thorough evaluation of student abilities ( 25 ). Nevertheless, our research found that although students valued the creative methods enabled by electronic assessments, some still had reservations regarding the level of assessment in comparison to conventional techniques. This research reveals how electronic assessments can improve educational experiences by decreasing student stress and increasing satisfaction. However, addressing the technical, logistical, and infrastructural challenges linked to the implementation of these systems is essential. Our research provides important information on the challenges faced by medical students in Iran during the transition to online assessments, highlighting the importance of ongoing enhancements and assistance for virtual learning in academic institutions. By tackling these obstacles and capitalizing on the advantages of digital assessments, universities can establish a more efficient, trustworthy, and student-focused method of education. Future research should prioritize conducting longitudinal studies to monitor shifts in student attitudes towards electronic assessments over time, along with exploring the distinct aspects of assessment quality that impact satisfaction. Investigating how digital literacy impacts student experiences may reveal essential skills for effectively navigating online exams. Comparing studies in diverse fields could offer understanding on how different educational environments impact student involvement and contentment. Furthermore, including input from teaching staff would provide a more thorough insight into the obstacles and potential advantages of incorporating digital assessments. Focusing on these areas in upcoming research will improve the efficiency and flexibility of digital assessments in educational environments. Limitations This research faced various constraints that could impact the applicability and precision of the results. Initially, the participation of students in filling out the surveys was lower than expected. To address this problem, increasing proactive measures such as timely follow-ups and allowing enough time for questionnaire completion could improve participation rates. Additionally, there is a possibility that some participants chose not to respond to specific questions, which could lead to a bias in the data. Enforcing mandatory response requirements for every question may solve this issue and promote more thorough data gathering. Furthermore, bias could be introduced by the truthfulness of participants when completing the surveys. In order to address this issue, participants were guaranteed that their answers would be kept private, creating a safe space for open and honest feedback. Furthermore, the use of self-reported data may introduce biases, as individuals could be more inclined to provide answers that are socially acceptable rather than expressing their genuine opinions. Even though steps were taken to guarantee privacy, there is still a possibility of bias affecting the outcomes. Finally, although ethical issues were taken into account such as getting consent from participants and protecting the anonymity of their answers, there could still be difficulties in upholding this confidentiality, especially in online settings. In order to enhance the ethical standards of the research, participants were notified that they had the option to exit the study at any point without facing any consequences, allowing them independence in the research procedure. Overall, these restrictions underscore the importance of thoughtful analysis when interpreting results and indicate opportunities for enhancing future research approaches. Conclusion In conclusion, the move to virtual and electronic exams offers a chance to improve student experiences in higher education. Our results show that these evaluations have the potential to reduce student anxiety and enhance general contentment, highlighting the capacity of digital resources in developing adaptable and encouraging educational settings. Nevertheless, in order to fully reap these advantages, it is crucial to tackle the related obstacles such as technical hurdles, legal factors, and content distribution challenges. Ongoing research and development will be crucial in improving virtual assessment systems in educational institutions to better meet the diverse needs of students and faculty as they are increasingly being implemented. Given the changing online education environment, it is crucial to prioritize understanding student experiences, especially in the current pandemic circumstances. This research provides valuable understanding of the intricacies of online tests, guiding enhancements and advancements in virtual evaluation platforms. By utilizing these discoveries, universities in Iran can create more effective, dependable, and student-focused methods for online learning, ultimately promoting an atmosphere that supports academic achievement and happiness. Declarations Acknowledgements The authors acknowledge the financial support from Abadan University of Medical Sciences. Authors' Contribution Sadegh Sharafi and Saeed Jelvay participated in the research project. Hossein Valizadeh Laktarashi, Zeynab Naseri, Majid Ahmadpour, Ferdos Hadideh, and Sara Mobarak were also involved in the data collection. Bagher Pahlavanzadeh and Ahlam Almanie assisted with the statistical analysis of this research. Sadegh Sharafi and Hosna Salmani participated in data interpretation and manuscript preparation. Data Availability The datasets used and analysed in this study is available upon reasonable request from the corresponding author. Competing interests The author(s) declare no competing interests. Ethical Approval The present article is the result of a research project approved by Abadan University of Medical Sciences with the number IR.ABADANUMS.REC.1399.210. We acknowledge that all methods were performed by the relevant guidelines and regulations. Funding/Support This study was funded by Abadan University of Medical Sciences, Abadan, Iran. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6116030","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":425996363,"identity":"5bc3d405-40a6-49a7-80c8-b027118176ad","order_by":0,"name":"Sadegh Sharafi","email":"","orcid":"","institution":"Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran","correspondingAuthor":false,"prefix":"","firstName":"Sadegh","middleName":"","lastName":"Sharafi","suffix":""},{"id":425996364,"identity":"ce44de22-642e-4f82-8eeb-7bec2614f836","order_by":1,"name":"Hosna Salmani","email":"","orcid":"","institution":"School 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Iran","correspondingAuthor":false,"prefix":"","firstName":"Ferdos","middleName":"","lastName":"Hadideh","suffix":""},{"id":425996370,"identity":"0f916356-c53d-4a2c-b89c-05fac51414aa","order_by":7,"name":"Sara Mobarak","email":"","orcid":"","institution":"Abadan University of Medical Sciences, Abadan, Iran","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"Mobarak","suffix":""},{"id":425996371,"identity":"26a86c0f-13a4-461d-92ac-7fb3eaf9e604","order_by":8,"name":"Ahlam Almanie","email":"","orcid":"","institution":"Department of Medical Physics, School of Medicine, Tarbiat Modares University, Tehran, Iran","correspondingAuthor":false,"prefix":"","firstName":"Ahlam","middleName":"","lastName":"Almanie","suffix":""},{"id":425996372,"identity":"5837452a-3721-426b-931c-2b29d8c2580a","order_by":9,"name":"Saeed Jelvay","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBAC+QaGBIYHQAY/iJdQQIQWgwNALQlAhmQDSIsBMVrAhkP0wriEtTx8kNhml7j5/OrEDw8MGOT5xQ7g1wL0S7JBYlty4rYbbzdLAB1mOHN2AgFrDjCkSSScYQZqObsBpCXB4DZhLek/Es7UJ26ecXbzD2K1pDEkVBxO3MDfu404WwwOMyRLJFQcN55xg3ebRYKBBGG/yLf3JH74YFAt299/dvPNHxU28vzShBzGzANW4dggAaYlCCgHA/YDINKegf8AMapHwSgYBaNgJAIAfb9IqQ7Y4jUAAAAASUVORK5CYII=","orcid":"","institution":"Abadan University of Medical Sciences, Abadan, Iran","correspondingAuthor":true,"prefix":"","firstName":"Saeed","middleName":"","lastName":"Jelvay","suffix":""}],"badges":[],"createdAt":"2025-02-26 21:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6116030/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6116030/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78236788,"identity":"435e657f-3ea9-4f2f-810e-5610dd5235b2","added_by":"auto","created_at":"2025-03-11 08:32:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75278,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between Various Components of Virtual Education and Student Satisfaction\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6116030/v1/6c47f40f2587cb6df0e4afd0.png"},{"id":78238033,"identity":"c83fa239-eab3-42d9-a598-639a9c174247","added_by":"auto","created_at":"2025-03-11 08:40:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":822967,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6116030/v1/19ab168a-dff9-4ccc-9652-8d4725fa00f4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Survey of Students' Views on Online Exams at Medical Universities in Iran During the COVID-19 Outbreak","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe COVID-19 pandemic changed education systems all over the world, and higher education institutions had to adjust to remote learning and assessment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Medical universities had it tougher, given the high stakes of medical education and the practical skills required for training healthcare professionals (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Iran like many other countries, the pandemic forced us to switch from traditional in-person exams to online assessments and this raised questions about the effectiveness, reliability, and fairness of such methods in high-stakes environments (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Online exams with the help of technological tools emerged as a solution to continue education during lockdowns, But this was not without its challenges (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Medical students have unique pressures due to the intensity of their training (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). For many online exams were an unfamiliar format, with issues related to accessibility, technological readiness, and academic integrity (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These factors could affect not only students\u0026rsquo; performance but also their perception of the whole examination process (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The global health crisis called the pandemic which started in late 2019 is recognized by World Health Organization with a daily increase in the number of cases (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the beginning of 2020 when the pandemic started 1.5\u0026nbsp;billion students globally lost the opportunity to attend face-to-face classes and exams (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The pandemic presented risks and opportunities for universities and academic circles and we learned valuable lessons in online learning and getting ready for a new phase of creative teaching approaches. The COVID-19 outbreak in Iran during the second semester of the 98\u0026ndash;99 academic year forced us to implement electronic systems and online education to protect students (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Distance education emerged as a practical solution for these challenges (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Pandemic and geographical adjustment. The pandemic and geographical adjustment accelerated online education and digital platforms in the education sector. The rise in online education during the pandemic has provided students with the flexibility and accessibility to better handle their academic and personal duties. Nevertheless, the sudden shift posed notable difficulties, especially in Iran, as the digital education system was still evolving.\u003c/p\u003e \u003cp\u003ePrevious studies have focused on different elements of online education and evaluation. For example, Ranjdoost, et al (2019) discovered that virtual exams can greatly decrease student anxiety, highlighting the importance of a strong online exam system. Likewise, Ganji, et al (2017) showed a clear connection between online assessment quality and student contentment, highlighting the importance of enhancing exam quality for improving student experiences. A global survey by Coman et al. exposure to, found that technical difficulties, inadequate infrastructure, and isolation were barriers for students learning remotely during the pandemic which in turn made satisfying experience with written examinations online (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In addition, a study on medical students found they felt that online examinations are not fair due to concerns about cheating and the inability to replicate traditional exam atmosphere (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Specifically in Iran's context, where the educational infrastructures are quite different from urban to rural, those challenges might be more significant. Online exams also came with some benefits. For example, online assessments provided the flexibility and continuity of academic timetables that were needed internationally during a time of global uncertainty (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, online assessments promote more innovative methods of evaluation like open-book exams and problem-based assessment, which some educators feel assess critical thinking skills more effectively than traditional formats (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Unfortunately, gaining these benefits did not come without ensuring all students received a positive experience. Issues such as the nonavailability of the internet, lack of uniformity in exam monitoring, and increased anxiety due to newer surroundings had particular mention in concerns raised by medical students (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Additionally, the pandemic highlighted and widened existing disparities in access to technology due to the background status of students (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), causing a digital divide between lower classes and remote areas. Here's something very relevant, especially for Iran, where the competition to enter medicine is intense (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The perception of students about the transition towards online examination is important because it feeds back to universities, who can then work on mitigating these imperfections and giving place for refining future assessment strategies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Those insights can help inform policies that must be equitable yet effective in crisis situations (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aims to provide a comprehensive review of the views of medical students on online exams in Iran during the COVID-19 pandemic. It calls into question their experiences, what they faced challenges with, and how this benefitted them in terms of perceptions detailed findings on how these experiences affected the perception of online assessments. Through these perspectives, the study seeks both to add to the emerging medical education literature about online post-COVID-19 and to provide insights relevant to policy-makers and educators. The results of this survey will contribute to designing future examination systems and provide useful insights for better integration of technology in medical education. The world is still coming to terms with how most of these pandemics unfolded, and we must take all of this information into consideration in order to form a more sustainable education system for the future.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis descriptive study utilized a questionnaire to collect data from students in medical universities across Iran. The survey was structured in two parts: demographic information (age, gender, education level, etc.) and core questions aimed at measuring student satisfaction with online exams. Responses were rated on a five-point Likert scale, where 1 indicated low satisfaction and 5 indicated high satisfaction.\u003c/p\u003e \u003cp\u003eTo ensure the validity and reliability of the questionnaire, it was reviewed by experts in virtual education. A pilot test was conducted with 10 participants to assess the clarity and functionality of the survey. The finalized questionnaire was then distributed electronically to the sample population.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Hypotheses\u003c/h2\u003e \u003cp\u003eThe study investigated several hypotheses:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThere is a significant relationship between demographic factors and students' satisfaction with the online exam system.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStudents' interest in virtual education is positively correlated with their views on online exams.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStudents' expectations for effective learning influence their satisfaction with online assessments.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe reliability of technology used in online exams affects students' perceptions of the system.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe method of course delivery impacts students' satisfaction with online exams.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eInteraction between students and faculty members plays a role in shaping students' views on online assessments.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExploratory Factor Analysis (EFA)\u003c/h3\u003e\n\u003cp\u003eThe EFA results indicated a Kaiser-Meyer-Olkin (KMO) measure of 0.937, and Bartlett's test was significant (χ\u0026sup2;(df\u0026thinsp;=\u0026thinsp;171)\u0026thinsp;=\u0026thinsp;17898.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Certain components, such as \"How do you evaluate the performance of the Education Office in timely notification of online exams?\" and \"How do you evaluate the technical support unit's services in addressing technical issues?\" showed cross-loadings and were subsequently excluded from further analysis. The remaining 19-component tool explained 73.42% of the total variance across five factors.\u003c/p\u003e\n\u003ch3\u003eConfirmatory Factor Analysis (CFA)\u003c/h3\u003e\n\u003cp\u003eThe CFA assessed the model fit for the proposed 5-factor; 19-component structure identified in the EFA. The reliability and validity of the model were confirmed. The Composite Reliability (CR) for all factors exceeded 0.7, and the Average Variance Extracted (AVE) for all factors surpassed 0.5, supporting the tool's reliability. Additionally, the AVE for all factors was greater than the Maximum Shared Variance (MSV), and the square root of the AVE for each factor was higher than the pairwise correlation coefficients between factors. Goodness-of-fit indices indicated an acceptable model fit: CFI\u0026thinsp;=\u0026thinsp;0.965, TLI\u0026thinsp;=\u0026thinsp;0.958, RMSEA\u0026thinsp;=\u0026thinsp;0.054 (95% CI: 0.05\u0026ndash;0.057), PCLOSE\u0026thinsp;=\u0026thinsp;0.052, and SRMR\u0026thinsp;=\u0026thinsp;0.044. (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Reliability and Validity Indices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAVE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMSV\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Office\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExam Content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstructor Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnical Unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.857\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eSample Size and Data Collection\u003c/h3\u003e\n\u003cp\u003eThe target population consisted of students from medical universities in Iran. Given that no similar studies have been conducted, a sample size of 1066 was determined using the formula for estimating proportions of a qualitative attribute, with Z\u0026thinsp;=\u0026thinsp;1.96, P\u0026thinsp;=\u0026thinsp;0.5, and d\u0026thinsp;=\u0026thinsp;0.03.\u003c/p\u003e \u003cp\u003eA stratified random sampling method was employed to ensure representation from all 64 medical universities. A total of 355 questionnaires were allocated to each type of university based on their student populations, and data collection continued until this number was reached for each type.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eInclusion criteria for the study comprised:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eVoluntary and informed consent\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEnrollment in a medical university in Iran\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCompletion of at least four online exams\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFamiliarity with online education systems.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eExclusion criteria included failure to complete the questionnaire.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analysed using SPSS version 21, employing both descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential statistics (independent t-tests, one-way ANOVA, chi-square tests, and correlation analyses).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study involved 1,517 students from medical universities across the country, of which 63.3% (960 students) were female. The majority of participants were between 20 to 25 years old, as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2. Demographics of Participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e960\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003eAge Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBelow 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1,166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eEducational Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAssociate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1,041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMaster\u0026apos;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePhD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe descriptive statistics for the five key components\u0026mdash;education, technical support, content, performance, and satisfaction\u0026mdash;are summarized in the following table. Among the components, technical support received the lowest mean score (2.48), and student satisfaction had the highest mean score (3.11). When comparing the mean scores of educations, technical support, and performance with satisfaction, the mean scores of educations, technical support, and performance were significantly lower (p \u0026lt; 0.05) than the satisfaction score (See Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3. Mean Scores for the Five Components\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComponent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTechnical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eContent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePerformance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSatisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn terms of gender, male students scored higher than female students in the performance and satisfaction components. For the age groups, students aged 20-25 had the highest mean scores in content, performance, and satisfaction, while those over 30 had the lowest (p \u0026lt; 0.05). Similarly, for the technical component, students in the age groups of 20-25 and 26-30 had the highest scores, while students under 20 scored the lowest (p \u0026lt; 0.05) (See Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4. Comparison of Mean Scores by Gender and Age Group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"725\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTechnical (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerformance (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatisfaction (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.81 \u0026plusmn; 0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2.47 \u0026plusmn; 0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e3.05 \u0026plusmn; 0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e3.01 \u0026plusmn; 1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3.18 \u0026plusmn; 1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.76 \u0026plusmn; 0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2.49 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e3.08 \u0026plusmn; 0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.88 \u0026plusmn; 0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3.06 \u0026plusmn; 0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eBelow 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.68 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2.34 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e2.91 \u0026plusmn; 1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.77 \u0026plusmn; 1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.84 \u0026plusmn; 1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e20-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.8 \u0026plusmn; 0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2.51 \u0026plusmn; 0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e3.11 \u0026plusmn; 0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.97 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3.17 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e26-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.73 \u0026plusmn; 0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2.51 \u0026plusmn; 0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e3 \u0026plusmn; 0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.96 \u0026plusmn; 1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3.15 \u0026plusmn; 1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eOver 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.67 \u0026plusmn; 1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2.47 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e2.85 \u0026plusmn; 0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.52 \u0026plusmn; 1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.68 \u0026plusmn; 1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFurthermore, a comparison of students at different educational levels showed that PhD students scored the highest in education, content, performance, and satisfaction, while Master\u0026rsquo;s students had the lowest mean scores (p \u0026lt; 0.05). For the technical component, Bachelor\u0026apos;s students had the highest scores, and Master\u0026rsquo;s students had the lowest (p \u0026lt; 0.05) (See Table 5).\u003c/p\u003e\n\u003cp\u003eTable 5. Comparison of Mean Scores by Educational Level\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"728\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTechnical (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerformance (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatisfaction (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAssociate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.71 \u0026plusmn; 0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.41 \u0026plusmn; 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.84 \u0026plusmn; 1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.75 \u0026plusmn; 1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.09 \u0026plusmn; 0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.77 \u0026plusmn; 0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.51 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.06 \u0026plusmn; 0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.86 \u0026plusmn; 1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.07 \u0026plusmn; 1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.53 \u0026plusmn; 0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.29 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.78 \u0026plusmn; 0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.57 \u0026plusmn; 1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.90 \u0026plusmn; 0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePhD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.85 \u0026plusmn; 0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.46 \u0026plusmn; 0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.18 \u0026plusmn; 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.23 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.27 \u0026plusmn; 1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to Figure 1, strong correlations were observed between student satisfaction with exam content, the performance of the education administration, the technical unit, and professors. The analysis revealed that professors\u0026rsquo; performance had the greatest impact on overall student satisfaction with online exams. Satisfaction with the educational administration and the technical unit played a similar role in determining overall satisfaction, but exam content did not significantly impact overall satisfaction. Collectively, these four components accounted for 51% of the variance in student satisfaction, leaving 49% unexplained.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe use of digital tools in education has significantly changed the way universities carry out assessments. This article combines results from studies in Iran and abroad to examine how electronic assessments impact student experiences, highlighting both similarities and differences with our own research results.\u003c/p\u003e \u003cp\u003eIn their 2018 study, Ranjdoust and colleagues investigated how virtual exams can help reduce stress among students and staff at Payame Noor University. Their results showed a notable decrease in stress-related symptoms like anxiety and emotional distress with the introduction of virtual assessments (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This is consistent with what we found in our research, as medical students also mentioned feeling that online exams have the ability to reduce stress. Both studies indicate the importance of enhancing the virtual assessment infrastructure to create a supportive testing environment.\u003c/p\u003e \u003cp\u003eOn the other hand, Arjenaki and colleagues (2017) investigated how assessment quality is related to student satisfaction, finding a positive connection indicating that improvements in e-assessment quality can greatly increase student satisfaction (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Although our results show a strong connection between students' satisfaction and the perceived quality of online assessments, the level of predictability (21%) highlighted by Arjenaki implies that assessment quality has a more significant impact than we initially thought. This difference highlights the necessity for more research on the particular aspects of quality that have the greatest effect on student satisfaction in different educational settings.\u003c/p\u003e \u003cp\u003eDespite significant progress, obstacles persist in the implementation of electronic testing in Iran, as pointed out by Habibi et al. (2016). These challenges include technical issues and worries about content delivery and security (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Our study confirms these findings by demonstrating that many students experienced similar challenges, particularly with regards to digital skills and the reliability of the technology used for virtual assessments. This common agreement underscores the pressing requirement for holistic approaches to address these issues and improve the overall efficiency of electronic assessments.\u003c/p\u003e \u003cp\u003eCosta et al. (2016) conducted a global assessment on the implementation of virtual learning platforms in nursing education, finding that a large majority of students showed a preference for using virtual tools to enhance their skill acquisition (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This corresponds to what we discovered, as medical students exhibited a favorable attitude toward the flexibility provided by online exams. Costa et al.'s study highlighting the link between virtual learning and increased motivation is consistent with our findings of boosted engagement in online evaluations.\u003c/p\u003e \u003cp\u003eStowell and Lamshed (2011) indicated recommendations for improving electronic assessments, emphasizing the importance of strong infrastructure and technical standards (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Our research strengthens this suggestion, promoting continuous investments in technological advancements to facilitate the successful execution of online evaluations.\u003c/p\u003e \u003cp\u003eIn the same manner, Allen and Seaman (2010) showed that electronic assessments are capable of assessing a wide variety of skills, which is in line with our discovery that online exams can contribute to a more thorough evaluation of student abilities (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Nevertheless, our research found that although students valued the creative methods enabled by electronic assessments, some still had reservations regarding the level of assessment in comparison to conventional techniques.\u003c/p\u003e \u003cp\u003eThis research reveals how electronic assessments can improve educational experiences by decreasing student stress and increasing satisfaction. However, addressing the technical, logistical, and infrastructural challenges linked to the implementation of these systems is essential. Our research provides important information on the challenges faced by medical students in Iran during the transition to online assessments, highlighting the importance of ongoing enhancements and assistance for virtual learning in academic institutions. By tackling these obstacles and capitalizing on the advantages of digital assessments, universities can establish a more efficient, trustworthy, and student-focused method of education.\u003c/p\u003e \u003cp\u003eFuture research should prioritize conducting longitudinal studies to monitor shifts in student attitudes towards electronic assessments over time, along with exploring the distinct aspects of assessment quality that impact satisfaction. Investigating how digital literacy impacts student experiences may reveal essential skills for effectively navigating online exams. Comparing studies in diverse fields could offer understanding on how different educational environments impact student involvement and contentment. Furthermore, including input from teaching staff would provide a more thorough insight into the obstacles and potential advantages of incorporating digital assessments. Focusing on these areas in upcoming research will improve the efficiency and flexibility of digital assessments in educational environments.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis research faced various constraints that could impact the applicability and precision of the results. Initially, the participation of students in filling out the surveys was lower than expected. To address this problem, increasing proactive measures such as timely follow-ups and allowing enough time for questionnaire completion could improve participation rates. Additionally, there is a possibility that some participants chose not to respond to specific questions, which could lead to a bias in the data. Enforcing mandatory response requirements for every question may solve this issue and promote more thorough data gathering. Furthermore, bias could be introduced by the truthfulness of participants when completing the surveys. In order to address this issue, participants were guaranteed that their answers would be kept private, creating a safe space for open and honest feedback.\u003c/p\u003e \u003cp\u003eFurthermore, the use of self-reported data may introduce biases, as individuals could be more inclined to provide answers that are socially acceptable rather than expressing their genuine opinions. Even though steps were taken to guarantee privacy, there is still a possibility of bias affecting the outcomes. Finally, although ethical issues were taken into account such as getting consent from participants and protecting the anonymity of their answers, there could still be difficulties in upholding this confidentiality, especially in online settings. In order to enhance the ethical standards of the research, participants were notified that they had the option to exit the study at any point without facing any consequences, allowing them independence in the research procedure. Overall, these restrictions underscore the importance of thoughtful analysis when interpreting results and indicate opportunities for enhancing future research approaches.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the move to virtual and electronic exams offers a chance to improve student experiences in higher education. Our results show that these evaluations have the potential to reduce student anxiety and enhance general contentment, highlighting the capacity of digital resources in developing adaptable and encouraging educational settings. Nevertheless, in order to fully reap these advantages, it is crucial to tackle the related obstacles such as technical hurdles, legal factors, and content distribution challenges. Ongoing research and development will be crucial in improving virtual assessment systems in educational institutions to better meet the diverse needs of students and faculty as they are increasingly being implemented.\u003c/p\u003e \u003cp\u003eGiven the changing online education environment, it is crucial to prioritize understanding student experiences, especially in the current pandemic circumstances. This research provides valuable understanding of the intricacies of online tests, guiding enhancements and advancements in virtual evaluation platforms. By utilizing these discoveries, universities in Iran can create more effective, dependable, and student-focused methods for online learning, ultimately promoting an atmosphere that supports academic achievement and happiness.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the financial support from Abadan University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSadegh Sharafi and Saeed Jelvay participated in the research project. Hossein Valizadeh Laktarashi, Zeynab Naseri, Majid Ahmadpour, Ferdos Hadideh, and Sara Mobarak were also involved in the data collection. Bagher Pahlavanzadeh and Ahlam Almanie assisted with the statistical analysis of this research. Sadegh Sharafi and Hosna Salmani participated in data interpretation and manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed in this study is available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present article is the result of a research project approved by Abadan University of\u003c/p\u003e\n\u003cp\u003eMedical Sciences with the number IR.ABADANUMS.REC.1399.210. We acknowledge that all methods were performed by the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Abadan University of Medical Sciences, Abadan, Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants were informed about the study\u0026apos;s purpose, and their informed consent was obtained before participation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbualadas HM, Xu L. Achievement of learning outcomes in non‐traditional (online) versus traditional (face‐to‐face) anatomy teaching in medical schools: A mixed method systematic review. Clinical Anatomy. 2023;36(1):50-76.\u003c/li\u003e\n\u003cli\u003eLucas HC, Upperman JS, Robinson JR. A systematic review of large language models and their implications in medical education. 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J Educ Strat Med. 2017;10(3):180-8.\u003c/li\u003e\n\u003cli\u003eHabibi H, Aghapoor B, Fatemi M, Khodayari S, Damirchi A, Rahimi A. Pathological approach to electronic tests in Iran (Case Study IBT TOEFL). Quarterly of Educational Measurement. 2016;7(24):145-70.\u003c/li\u003e\n\u003cli\u003eAvelino CCV, Costa LCSd, Buchhorn SMM, Nogueira DA, Goyat\u0026aacute; SLT. Teaching-learning evaluation on the ICNP\u0026reg; using virtual learning environment. Revista brasileira de enfermagem. 2017;70:602-9.\u003c/li\u003e\n\u003cli\u003eStowell R, Lamshed R, more AFLFS, Published: Brisbane Q, Australian Flexible Learning Framework,, paper RtGro, pagings Pdv, et al. E-assessment guidelines for the VET sector. Australian Department of Education, Employment and Workplace Relations(AFLF a N Q). 2011.\u003c/li\u003e\n\u003cli\u003eAllen IE, Seaman J. Learning on demand: Online education in the United States, 2009: ERIC; 2010.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, online exams, medical education, student satisfaction, e-learning, Iran","lastPublishedDoi":"10.21203/rs.3.rs-6116030/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6116030/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDuring the COVID-19 pandemic, medical universities in Iran have changed from traditional exams to online exams for their educational practices. This research explores medical students' opinions on online exams during this shift, seeking to assess their contentment and the elements affecting their interactions. A descriptive survey was accomplished by distributing a structured questionnaire to 1,517 medical students in different universities in Iran. The study gathered information on demographics and evaluated students' contentment with online exams through a five-point Likert scale. Data analysis included both descriptive and inferential statistics, including exploratory and confirmatory factor analyses. 63.3% of the participants were women. The results showed student satisfaction ratings differed by category, with technical assistance having the lowest average score of 2.48 and general satisfaction at 3.11. Strong connections were found between satisfaction and elements like exam content, technical support, and instructor performance. The shift to digital assessments has brought to light both possibilities and obstacles for medical education in Iran. Although online exams have the potential to decrease student anxiety and enhance contentment, there is a need for substantial enhancements in technical resources and assistance. This research provides valuable information that can help improve online assessment methods, leading to better virtual learning settings.\u003c/p\u003e","manuscriptTitle":"Survey of Students' Views on Online Exams at Medical Universities in Iran During the COVID-19 Outbreak","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-11 08:32:00","doi":"10.21203/rs.3.rs-6116030/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-08T05:34:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-03T11:58:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232487533348608026726172744353818066750","date":"2025-07-24T09:49:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-03T21:55:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338201892049674380337527404773267311151","date":"2025-03-28T00:11:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208259878934405596850770851936412789013","date":"2025-03-27T11:53:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-27T04:36:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-27T04:30:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-08T14:28:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-06T10:18:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-02-26T20:58:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"94bd7c8d-c7fa-4460-827c-37c35f41f9c0","owner":[],"postedDate":"March 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":45400213,"name":"Earth and environmental sciences/Environmental social sciences"},{"id":45400214,"name":"Earth and environmental sciences/Environmental social sciences/Environmental impact"}],"tags":[],"updatedAt":"2025-10-16T07:08:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-11 08:32:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6116030","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6116030","identity":"rs-6116030","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}