ORIGINAL RESEARCH

Differences in perception of online anesthesiology between

Thai medical students and teachers during the COVID-19
pandemic
Darunee Sripadungkul1, Suwitcha Sripadungkul2, Suhattaya Boonmak1 and Polpun Boonmak1

Departments of 1Anesthesiology and 2Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Purpose: Traditional anesthesiology learning was disrupted by the coronavirus disease 2019 pandemic and replaced by online
learning. Students and teachers did not prepare well for this change. Determining the differences in perceptions can close the
gap and develop more effective curricula. Our study aims to compare students’ and teachers’ perceptions of online anesthesiology
learning.
Methods: We conducted a prospective descriptive study, a cross-sectional survey between July 2020 and January 2021 in the
Anesthesiology Department, Faculty of Medicine, Khon Kaen University, Thailand. Our participants were fifth-year medical students
and teachers participating in online anesthesiology. We compared the perception of the teaching process, support system, learning
outcomes, satisfaction, and preference. Using an online structured questionnaire survey with a 4-point Likert scale to measure the
degree of agreement with each item. We analyzed the difference between students’ and teachers’ perceptions by topic.
Results: We received responses from 174 students and 24 teachers. Students had a significantly higher proportion of positive perceptions
than teachers on the teaching process (theoretical teaching, problem-based learning, feedback, and response system), on a support
system (technological support, connectivity, and learning materials), on learning outcomes (clinical practice readiness, critical thinking,
long-term memory, and enthusiasm), satisfaction score, and online learning preference (p<0.05).
Conclusion: Differences in perception were high in many aspects of online anesthesiology learning. This perception gap was
particularly evident in the teaching process, support system, and learning outcomes. And Thai students had more preference for
online learning than teachers. Strategies to reduce the gap should focus on teachers’ training and supporting online learning should
be concerned.

Key Words: Anesthesiology, COVID-19, Medical students, Online learning, Perception

Technological advances have made online learning

Introduction markedly more feasible and effective, allowing for asyn-

chronous learning, flexibility, simultaneous study, con-
The coronavirus disease 2019 (COVID-19) pandemic venient assessment, and for students to undergo self-
has greatly affected teaching in medical schools, dis- assessment before formal class sessions [3]. A systematic
rupting traditional teaching strategies and forcing many review comparing online and traditional learning reported
courses to be taught through distance learning [1,2]. comparable examination outcomes in undergraduate med-

Received: August 26, 2022 • Revised: November 4, 2022 • Accepted: December 2, 2022 Korean J Med Educ 2023 Mar; 35(1): 45-53
Corresponding Author: Suhattaya Boonmak (https://orcid.org/0000-0002-9959-4421) https://doi.org/10.3946/kjme.2023.248
Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, eISSN: 2005-7288
Thailand Ⓒ The Korean Society of Medical Education. All rights reserved.
Tel: +66.084.2003331 Fax: +66.043348390 email: [email protected] This is an open-access article distributed under the terms of the
Creative Commons Attribution Non-Commercial License (http://
creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted
non-commercial use, distribution, and reproduction in any medium,
provided the original work is properly cited.

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Darunee Sripadungkul, et al : Perception of online anesthesiology between students and teachers

ical education and did not find evidence indicating that and incentives to improve the satisfaction with online
offline learning was superior to online learning, making learning [10].
it a potential alternative education method in this context Traditional anesthesiology learning was disruptive by
[4]. However, online learning requires a reliable internet the COVID-19 pandemic and replaced with online
connection, capable hardware, and a sufficient level of anesthesiology learning [6]. Medical students and teachers
computer literacy. It also weakens the relationship be- did not prepare well for this change. The perception of
tween teachers and students and requires students to online learning between medical students and teachers
practice effective time management, including self- seems different [10,14,15]. We found uncertain results on
motivation [3]. Previous studies have shown that online the proportion of positive perceptions of online learning
learning has limitations in clinical and technical skill between students and teachers [10,14,15]. The causes of
training [5]. Online case-based learning in the teaching the difference in positive perception are essential to
of clinical anesthesia reported skill training limitations improve online learning with the concern for medical
and showed a negative effect on students’ attitudes [6]. students and teachers. Positive perception toward online
However, the study on anesthesia case-based online learning is a process of interpreting information received
learning reported higher satisfaction than conventional to create meaning. It is greatly influenced by the
case-based learning [6]. individual’s background, experience, sociocultural con-
While education in many Asian countries tends to be text, attitudes, personality, motives, feelings, interests,
teacher-centered and focused on rote learning and didactic and expectations [16]. Determining significant differences
lecture, students require self-study, self-motivation, and between students’ and teachers’ perceptions of online
a flipped classroom model in online learning [6-9]. A learning can close the gap between medical students and
previous study in an Asian country found that 89% of teachers and develop more effective curricula [10,14,15].
medical students reported being less satisfied with online Lessons from online anesthesiology learning may expand
learning [10]. Common problems among students were to better understand students’ and teachers’ perceptions.
connectivity, the interaction between students and In Thailand, medical education requires 6 years (3 for
teachers, feedback systems, and course materials [11]. pre-clinical studies and another 3 for clinical studies).
Previous studies reported that factors affecting student According to our curriculum, students take anesthesiology
satisfaction were quality with five dimensions: content, in their fifth year. The course aims to train students in
system, learner, instructor, and interaction. That should the safe administration of anesthesia, focusing on im-
be directed toward improving interactive teaching styles, parting knowledge and both technical and non- technical
collaborative activities, proper training for online learning skills. Before the pandemic, fifth-year medical students
prior to online learning, quality of content, and a good at Khon Kaen University received 3 weeks of blended
performance online learning system [12]. At the same time, courses consisting of interactive lectures, case- based
teachers reported less satisfaction with online learning discussion, simulated skill training, real-world practice,
than students in the Asian country [13]. Insufficiency and online material. However, due to the COVID-19
training, higher workload, long preparation time, and pandemic, our department was forced to replace these
technical problem were addressed as the cause of traditional methods with online learning. The interactive
unsatisfied. Teachers require training, technology support, lectures and case-based discussions in the onsite section

46 Korean J Med Educ 2023 Mar; 35(1): 45-53.

 Darunee Sripadungkul, et al : Perception of online anesthesiology between students and teachers

of the course were replaced with interactive online responding system, and an online knowledge evaluation.
learning. Students’ clinical practice began 5 months after We excluded participants who did not respond to the
the online section due to limitations brought about by the online questionnaire.
pandemic. So, we aimed to study the difference in
1. Outcome measurement
perception between medical students and teachers of
online learning in an anesthesiology course after a We designed and developed a structured questionnaire
disruptive traditional class from the COVID-19 pandemic. based on previous studies and adjusted it for use in a Thai
We evaluated their positive perception of the teaching context [10,15]. An expert panel in the content area was
process, support system, learning outcomes, satisfaction, consulted to improve content validity. We conducted a
and online preference. The result helps us to understand pilot study. We included five teachers and 10 medical
the effect of online anesthesiology learning on the students who did not participate in the study to reduce
perception of students and teachers and seek the obstacle the bias. We determined the survey’s reliability and made
to close the gap and increase satisfaction with online the necessary modifications based on the results. Re-
anesthesiology learning among students and teachers. liability was assessed using Cronbach’s α coefficient and
determined to be acceptable (0.88 for the questionnaire).
The 25-question questionnaire consisted of three sections

Methods (Supplements 1, 2). The first section evaluated participant

characteristics, including gender, age, previous experience
This prospective descriptive study was based on a with online learning and the number and type of devices
cross-sectional online survey to compare perceptions of used for online learning. The second section evaluated
online anesthesiology learning between students and recipients’ perception of online learning during the
teachers. We conducted the study at the Anesthesiology anesthesiology course, focusing on the teaching process,
Department, Faculty of Medicine, Khon Kaen University support system, learning outcomes, and preference for
(Thailand), between July 1, 2020, and January 31, 2021. online learning. We used a 4-point Likert scale to measure
We obtained approval from the Khon Kaen University the degree of agreement with each item (1=strongly
review board before the commencement of the study disagree; 2=disagree; 3=agree; 4=strongly agree). Agree
(HE631499). The study was analyzed and presented with and strongly agree were considered positive perceptions.
the Strengthening the Reporting of Observational Studies The third section consisted of three questions to evaluate
in Epidemiology (STROBE) guidelines. Trial registration participants’ satisfaction using a 5-point Likert scale
number is TCTR20210430003 (Thai Clinical Trials Registry). (1=strongly disagree; 2=disagree; 3=neither agree nor
We included fifth-year medical students who had disagree; 4=agree; 5=strongly agree). We did not record
participated in online anesthesiology learning and the the respondents’ names to preserve anonymity. The ques-
teachers who had all taught anesthesiology via online tionnaire took about 10 minutes to complete. Participants
learning at least once during the study period. The online were recruited using an online survey (Google Forms;
anesthesiology learning system comprises 17 online Google LLC, Mountain View, USA). The first page of each
interactive lectures, 17 topics of online learning material, questionnaire described the purpose of the study and
two online case-based discussions, online feedback and information about participation (including the right to

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Darunee Sripadungkul, et al : Perception of online anesthesiology between students and teachers

withdraw). Participants filled out an electronic consent in online learning by topic and were analyzed using
form before taking the online questionnaire. Only after Fisher’s exact test or Pearson’s chi-square test and
agreeing to participate could potential respondents con- presented as frequency and percentage. Differences in
tinue to the online survey. We distributed the ques- course satisfaction between groups were analyzed using
tionnaires through the participants’ university e-mails and Student t-test and reported as mean (standard deviation)
the official department LINE group (LINE Corp., Tokyo, and p-value. The estimated required sample size was 140
Japan) 5 months after the online learning. In addition, we students and 23 teachers, as calculated using the formula
sent out a reminder to our contacts to encourage them to for a finite population with a margin of error of 5%, and
fill out our survey. a confidence level of 95%. The total population consisted
of 219 students and 24 teachers.
2. Statistical analysis

Data analysis was performed using IBM SPSS Statistics

for Windows ver. 22.0 (IBM Corp, Armonk, USA). We used Results
descriptive statistics to describe participant charac-
teristics. We calculated the proportion using the number Participants in online learning during the study period
of participants with non-missing data. We compared were 219 fifth-year medical students and 24 teachers (Fig.
students’ and teachers’ proportion of positive perceptions 1). We received questionnaire responses from 174 medical

Fig. 1. Study Flow Diagram

48 Korean J Med Educ 2023 Mar; 35(1): 45-53.

 Darunee Sripadungkul, et al : Perception of online anesthesiology between students and teachers

students (79.5%) and 24 teachers (100%) who were an- problem-based learning (92.5% versus 75.0%), and feed-
esthesiologists. The median (interquartile range) student back and response system (94.3% versus 54.2%) than
age was 23 (22–23) years, and 47.1% were female. That teachers (p<0.05). However, the proportion of positive
of the teachers was 37.5 (34–46) years, and 62.5% were perception in knowledge evaluation was comparable
female. Most participants had experience with online (79.3% versus 70.8%).
learning (92.0% of students and 79.2% of teachers). All Fig. 3 compares the support system’s positive per-
students used a single device during online learning (laptop ception between medical students and teachers. Medical
computer=59.2%, tablet=23.0%, desktop computer=13.8%, students had a higher proportion of positive perception
smartphone=4.0%), while 83.3% of teachers used more in technological support (97.1% versus 83.3%), device and
than one device while teaching (smartphone=66.7%, connectivity (93.1% versus 79.2%), and learning materials
laptop computer=66.7%, desktop computer=58.3%). (83.9% versus 41.7%) with a p<0.05. However, the
Fig. 2 compares the perception between medical stu- proportion of positive perception rate was comparable in
dents and teachers in the teaching process. Medical information support (99.4% versus 100.0%).
students had a significantly higher proportion of positive Fig. 4 compares the proportion of positive perceptions
perception in theoretical teaching (85.1% versus 58.3%), between medical students and teachers in the learning
outcomes. Medical students showed a higher proportion
Fig. 2. The Proportion of Positive Perception in the Teaching Process
between Students and Teachers of positive perception in clinical practice readiness (76.4%
versus 25.0%), critical thinking (93.1% versus 62.5%),
long-term memory (80.5% versus 37.5%), and enthusiasm

Fig. 4. The Proportion of Positive Perception in the Learning Outcomes

between Students and Teachers

*p<0.05 (statistically significant).

Fig. 3. The Proportion of Positive Perception in the Support System

between Students and Teachers

*p<0.05 (statistically significant). *p<0.05 (statistically significant).

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Darunee Sripadungkul, et al : Perception of online anesthesiology between students and teachers

Table 1. Course Satisfaction and Preference in Online Anesthesiology Learning between Students and Teachers
Topic Student group (N=174) Teacher group (N=24) p-value
Satisfaction score
Overall course 4.06±0.75 3.21±0.83 <0.001*
Teaching process 4.23±0.65 3.42±0.72 <0.001*
Evaluation technique 3.94±0.80 3.46±0.78 0.005*
Online learning preference 135 (77.6) 3 (12.5) <0.001*
Data are presented as mean±standard deviation or number (%).
*p<0.05 (statistically significant).

(81.0% versus 37.5%) with a p<0.05. Their proportion of long-term memory, and enthusiasm was also found.
positive perception in professionalism (87.4% versus Students’ satisfaction scores were significantly higher than
83.3%), clinical application (90.8% versus 95.8%), positive teachers’ satisfaction scores, including a percentage of
environment (94.3% versus 87.5%), and effective time online learning preference over onsite learning.
management (90.2% versus 79.2%) were comparable. During the COVID-19 pandemic, many medical schools
Table 1 compares satisfaction scores and preferences for have turned to online learning platforms to facilitate
online anesthesiology learning. Students’ mean (standard learning while maintaining social distancing. However,
deviation) satisfaction scores were significantly higher in online learning can present challenges to students and
the areas of the overall course, teaching process, and teachers used to traditional forms of learning. In addition,
evaluation technique (p<0.05). Students’ satisfaction the sudden transition from face-to-face teaching to online
scores ranged from 3.94–4.23, while those of the teachers learning has not allowed adequate preparations to be made
ranged from 3.21–3.46. The percentage of online learning in many instances [10,17]. Participant characteristics may
preference over onsite learning of students was sig- have influenced the perception gap between students and
nificantly higher than teachers (77.6% versus 12.5%) with teachers in our study. Younger age and more experience
a p<0.05. with online learning in students may result in a more
proportion of positive perceptions. They tend to be more
adept with modern technology than teachers [2,5].

Discussion Additionally, in our study, most teachers use more than

one device during teaching, which may cause a less
We included 174 fifth-year medical students and 24 positive perception of technology support and con-
anesthesiology teachers in the study. Students had a higher nectivity [14].
proportion of positive perceptions than teachers for many Students showed a high proportion of positive per-
aspects of the teaching process: theoretical teaching, ceptions in every aspect of the teaching process. At the
problem-based learning, and feedback and response same time, teachers showed a low proportion of positive
system. Students also reported a higher proportion of perceptions of theoretical teaching and feedback and
positive perceptions of technological support, device and response system. During learning, we provided both lived
connectivity, and learning materials in a support system. and recorded lectures to students, including learning
A higher proportion of positive perceptions of the learning materials that may be the cause of indicated highly positive
outcomes on clinical practice readiness, critical thinking, perceptions of theoretical teaching. In the feedback and

50 Korean J Med Educ 2023 Mar; 35(1): 45-53.

 Darunee Sripadungkul, et al : Perception of online anesthesiology between students and teachers

response system, despite we employed real-time online ferred online learning. This may have been due to the
feedback and a question-and-answer system to reduce the sudden transition making it difficult for teachers-but not
communication gap. However, in teachers’ view, face-to- students (who tend to be more flexible)-to adapt. Although
face feedback is better communication and allows for we studied in a developing country, our satisfaction seems
immediate feedback than online learning, as found in high. In contrast, a previous study showed that online
previous studies [18,19]. learning satisfaction levels in students in developed
The percentage of positive perception in the support countries are higher than in developing countries [5].
system was high among students and teachers except for However, online learning satisfaction is associated with
learning materials. Our results contrast with a previous technical support, learning materials, connectivity,
study that found that teachers felt a lack of support for interactive learning, and feedback system [10,11]. Our
technical difficulties, technology training, and infor- online anesthesiology learning may meet those factors.
mation technology support [10]. Most teachers in our We found that Thai students showed a higher proportion
department were familiar with information technology, of positive perception of online learning than Thai
and online learning techniques were prepared for many teachers in every aspect. Thai medical students may be
years. However, the proportion of positive perceptions in ready for online anesthesiology learning, but not Thai
learning materials was low among teachers. This result is medical teachers. Teacher preparation and support system
similar to a previous study that reported that online should be a concern when beginning online learning.
learning materials resulted in higher workloads and taking Previous studies in Asian countries found that teachers’
longer to prepare teacher lessons [10]. limited skills in using technology were one of the major
The student’s high proportion of positive perceptions problems of online medical education. Educating teachers
in learning outcomes were around 80% and above. In to transform the idea is essential for medical schools [14].
contrast, teachers reported a low proportion of positive We recommend further study focused on the factors
perception in learning outcomes, especially for clinical associated with the perception of online learning in Asian
practice readiness, long-term memory, and enthusiasm. culture teachers aiming to increase their positive per-
The results are similar to a previous study that found that ceptions.
teachers feel that online learning may compromise Our outcomes should be interpreted with caution with
students’ clinical competence and confidence [20]. The several limitations. Our study was performed only in a
integration of online learning into existing medical single setting, meaning that it may be limited in
curricula should result from a well-devised plan for a generalization to other populations. We only included Thai
proportion of positive perception of learning outcomes. participants, who tend to be less or more familiar with
It is best to begin with an integrated onsite and online online learning than some other populations. We studied
learning strategy that considers the benefits and burdens their opinion on the perception of our learning platform,
of blended learning before revising the curriculum [21]. so it may have uncontrollable factors that affect the
Course satisfaction is a critical factor in online learning. outcome. Further studies in other settings should be
Our students indicated high satisfaction with all items in conducted to better assess the utility of online platforms
this area. Most accepted online learning as an alternative as a mode of teaching. Finally, our students took the online
educational tool. However, only 12.5% of teachers pre- questionnaire 5 months after finishing the course, which

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Darunee Sripadungkul, et al : Perception of online anesthesiology between students and teachers

may have led to recall bias. Polpun Boonmak: https://orcid.org/0000-0001-9011-528X

We found differences in the proportion of perception Acknowledgements: We would like to acknowledge
in online anesthesiology learning between Thai students Miss Piyanan Suparattanagool, Clinical Epidemiology
and teachers. Thai medical students indicated a higher Unit, for assistance with the biostatistics and our staff and
proportion of positive perceptions in online anesthe- medical students for participating in our study.
siology learning in every aspect than teachers. This Funding: No financial support was received for this study.
perception gap was particularly evident in the areas of Conflicts of interest: No potential conflict of interest
teaching technique and learning outcomes. Our results also relevant to this article was reported.
showed that students indicated higher satisfaction with Author contributions: SD, SS, BS, and BP conceived,
online learning than teachers. Strategies to reduce the gap designed, and developed the study protocol. SD, BS, and
should focus on teachers’ training and support of online BP designed and tested the study instrument. SD, BS, and
learning should be a concern. BP supervised data collection. SD, SS, BS, and BP
In conclusion, differences in perception were high in analyzed the data. SD, SS, BS, and BP prepared and
many aspects of online anesthesiology learning. This approved the manuscript. All authors read and approved
perception gap was particularly evident in the teaching the final manuscript
process, support system, and learning outcomes. And Thai
students had more preference for online learning than
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