Journal of Modern Medical

Introduction
The development of virtual education and e-learning has received great attention in recent years in Iran with the development of technology and its increasing influence on the teaching and learning process. Today, the development of web-based learning tools is one of the benefits of technology in the field of education [4]. According to Randy Thomas [5], the main advantages of using virtual education are reduced educational costs, improved performance and productivity, acceleration of access to the market, facilitation of recruitment, and provision of the opportunity to update knowledge. The outbreak of Corona caused education systems to gain valuable experiences in the field of virtual education and be ready to enter a new era of education with modern approaches. In Iran, from the beginning of the second half of the academic year 2019-2020, the COVID-19 pandemic caused universities to use electronic systems and virtual education to maintain the health of students. This research aims to determine the factors affecting the satisfaction of medical students in Iran with virtual education during the COVID-19 pandemic.

Methods
This is a descriptive-analytical study that was conducted in 2020. The study population consists of all students of medical universities in ten cities of Iran. Using a convenience sampling method, 1300 students were selected. To collect information, a researcher-made questionnaire with a reliability of 0.76 was used. The questionnaire included two parts: demographic form and main section. The demographic form surveys age, sex, marital status, educational level, university of study. The main questions measures student satisfaction, which has 7 dimensions (satisfaction level, way of presenting lessons to students, fulfillment of expectations, teacher-student interaction, interest/attitude, and reliability/trustworthiness of the technology). The items are rated on five-point Likert scale from 1 (very low) to 5 (very high). A score ≥3 indicates good satisfaction, and a score <3 indicates low satisfaction. Questionnaires were sent to students online. After completing the questionnaires, the data were analyzed in SPSS software, version 22.

Results
A total of 1192 students completed the questionnaire, of whom 358 were male and 834 were female. Most of them (n=873, 73.2%) were undergraduate students aged 20-25 years (n=887, 74.4%). There was a statistically significant difference in the satisfaction of medical students in terms of demographic variables (sex, educational level, age). The mean score of satisfaction was 12.85 for males and 13.78 for females (P=0.001). There was a significant difference in the mean score related to the method of presenting lessons by teachers between male and female students (P=0.007). There was also a significant difference in the method of presenting lessons among students with different educational levels (P=0.0001) and age (P=0.026). The highest level of students’ satisfaction was in the two domains of the method of presenting lessons to students and the fulfillment of students’ expectations, followed by the domains of teacher-student interaction, interest/attitude, and reliability/trustworthiness of the technology. There was a significant correlation among all domains of the satisfaction scale.

Conclusion
The satisfaction of medical students in Iran with virtual education during the pandemic is a favorable level. The way of presenting lessons, fulfillment of students’ expectations, teacher-student interaction, interest/attitude, and reliability/trustworthiness of the technology had a significant relationship with the satisfaction of medical students in Iran with virtual education during the pandemic. Solving related problems and providing necessary facilities can help improve the quality of course delivery and consequently the satisfaction of medical students. Fulfilling student’s expectations to understand and learn course materials and the existence of suitable and stable technological conditions can also improve the satisfaction of medical students with virtual education.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethic Committee of Abadan University of Medical Sciences (Code:.IR.ABADANUMS REC.1399.185).

Funding
This article was done with the financial support of Abadan University of Medical Sciences.

Authors' contributions
Initial idea, proposal development and data gathering: Sadegh Sharfi; Drafting of the proposal, notification for gathering information and preliminary editing of the article: Sajideh Rehdar; Consulting in processing the initial idea and formulating an online questionnaire and supervising data analysis: Saeed Jalvai; Information gathering and data entry: Zainab Naseri; Data analysis and initial compilation of the findings section: Fatemeh Maqsoudi; Consultation and supervision in the preparation of the proposal: Sara Mubarak; Advice on drafting the proposal, methodology, final approval: Mehbobeh Mumtazan.

Conflicts of interest
The authors declared no  conflict of interest.


References

1. Karimian Z. [Impact of summer school e- learning with a blended approach on knowledge, skill and attitude of participating students (Persian)]. Res Med Educ. 2020; 12(2):39-49. [DOI:10.29252/rme.12.2.39]
2. Ostad SN, Ahmady S, Mohammadi A, Sabzevari O, Mojtahedzadeh R, Razavizadeh M, et al. [Evolution of e-Learning in Iran’s Medical Sciences Universities: Formation of virtual university of medical sciences (Persian)]. Teb va Tazkiyeh. 2019; 27(4):233-43. [Link]
3. Sاams G, Tari F, Rezaeezadeh M. [Identification of fundamental and managerial challenges of applying E-learning in human resources education (Persian)]. Res Teach. 2019; 7(3):116-91. [DOI:10.34785/J012.2019.981]
4. Khoshnoodifar M, Rafie S, Zeraati Nasrabadi M, Masoudi Alavi N. [The effects of CPR training using two traditional and electronic training methods on the knowledge, skill, and satisfaction of nurses from in service education of cardiopulmonary resuscitation (Persian)]. Qom Univ Med Sci J. 2019; 13(9):34-43. [DOI:10.29252/qums.13.9.34]
5. Saberi A, Kazempour E, Porkar A. [Feasibility of utilizing virtual education from the viewpoints of professors,students and information technology staff (IT) in Guilan University of Medical Sciences (Persian)]. Res Med Educ. 2018; 10(1):21-9. [DOI:10.29252/rme.10.1.29]
6. Firoozehchian F. [The use of podcast in education a new approach in development of E-learning (Persian)]. Res Med Educ. 2016; 8(1):1-2.  [DOI:10.18869/acadpub.rme.8.1.1]
7. Narenjithani F, Pourkarimi J, Hejazi S. [Identifying the components of e-learning system at university of Tehran (Persian)]. Technol Educ J. 2021; 15(2):321-37. [DOI:10.22061/tej.2020.6130.2336]
8. Khazaei Jalil S, Shahbazian B, Montazeri AS, Abbasi A. [The impact of educational software designed on operating room students' learning of practical skills (Persian)]. Res Med Educ. 2015; 7(4):13-9. [DOI:10.18869/acadpub.rme.7.4.13]
9. Rostami B, Ramazani Badr F, Armani kian A, Moein Z. [The relationship among students' perceptions of learner support system´s quality with academic performance and academic adaptation in Zanjan University of Medical Sciences (Persian)]. Res Med Educ. 2019; 11(3):12-21 [DOI:10.29252/rme.11.3.12]
10. Sayah G, Derakhshanfard S. [The inhibitory factors of using E-learning in Urmia University of Medical Sciences from the students' point of view (Persian)]. Iran J Med Educ. 2019; 19:371-80. [Link]
11. Mirhaji SS, Soleymanpour M, Saboury AA, Bazargan A. [A look at the Corona virus and the evolution of university education in the world: Challenges and perspectives (Persian)]. Environ Manag Hazards. 2020; 7(2):197-223. [DOI:10.22059/jhsci.2020.311822.604]
12. Mostafavi ZS, Kamal Kharazi SAN, Narenji Thani F. [Investigation level the student’s interactions with others and their in E-learning environment: The case of Mehr-Alborz University (Persian)]. Train Learn Res. 2016; 13(1):21-36. [Link]
13. Zeinoddini M. [Reasons for the creation of the new coronavirus 2019 (SARS-CoV2): Natural mutation or genetically laboratory manipulation-point of view (Persian)]. J Rafsanjan Univ Med Sci. 2020; 19(7):749-64. [DOI:10.29252/jrums.19.7.749]
14. Iranmanesh F, Ostadebrahimi H, Mirzazadeh A, Azin M. [Performance report of distance learning at Rafsanjan University of Medical Sciences during the COVID-19 pandemic (Persian)]. J Rafsanjan Univ Med Sci. 2020; 19(4):423-8. [DOI:10.29252/jrums.19.4.423]
15. Saeidi Z, SHarafinezhad H. [An electronic package to improve teaching and evaluation of persian core vocabulary (Persian)]. J Persion Lang Teach Non Persion Speake. 2013; 2(1):135-54. [Link]
16. Mian A, Khan S. Medical education during pandemics: A UK perspective. BMC Med. 2020; 18(1):100. [DOI:10.1186/s12916-020-01577-y] [PMID] [PMCID]
17. Farokhi M. [A survey of Tehran Refah College students’ evaluation of virtual education in the corona period (Persian)]. Relig Commun. 2021; 28(59):274-47. [Link]
18. Mohammadi M, Sarmadi M, Farajolahi M, Ghoban Nia AA. [Study of the status of virtual higher education in terms of education services provided in Iran (Persian)]. J Res Educ Syst. 2015; 9(29):32-54. [Link]
19. Zhalehjoo N, Arabi M, Momeni Z, Akbari Kamrani M, Khalili A, Riahi S, et al . [Virtual education status from the perspective of students at Alborz University of Medical Sciences in the Covid-19 pandemic period (Persian)]. J Med Educ Dev. 2021; 14(42):37-45. [DOI:10.52547/edcj.14.42.37]
20. Masoomifard M. [Study of the Relationship of the various Interaction Types in E-learning with Collaborative Learning Quality (Case Study of Master’s Students in Environmental Education) (Persian)]. Environ Educ Sustain Dev. 2019; 7(3):103-14. [DOI:10.30473/ee.2019.5811]
21. Ghanbari S, Rezghi Shir Savar H, Zeiaei MS, Mosleh M. [Evaluating the effectiveness of virtual education on health care management students (Persian)]. J Healthc Manag. 2019; 10(2):49-60. [Link]
22. Avelino CCV, Costa LCSD, Buchhorn SMM, Nogueira DA, Goyatá SLT. [Teaching-learning evaluation on the ICNP® using virtual learning environment (English, Portuguese)]. Rev Bras Enferm. 2017; 70(3):602-9. [DOI:10.1590/0034-7167-2016-0545] [PMID]
23. Sarboland K. [Evaluation of the effectiveness of e-Learning on satisfaction of graduate students of Islamic Azad University units of northwest of Iran (Persian)]. J Technol Educ. 2020; 14(1):63-74. [DOI:10.22061/jte.2018.4091.1999]
24. Kazempour N, Kiapasha K, Faraji M, Ghanbari Hamidabad M, Zare Sheykhkolai SF, Mohammadzade M. [Analyzing the challenge of university culture components in virtual education: A case study (Persian)]. J Educ Stud. 2022; 7(26):16-28. [DOI:20.1001.1.25884182.1400.7.26.2.8]
25. Abbasi Z, Kelari F. [International students’ attitudes toward online courses and social media in Persian language learning: Before and after COVID-19 (Persian)]. J Sociolinguistics 2020; 3(4):39-51. [DOI:10.30473/il.2020.53184.1365]
26. Khalifa Soltani MS, Rahmani J. [Virtual education in the university and its demand from the perspective of professors and students (Persian)]. Res Human Islam. 2017; 3(11):121-31. [Link]