From pandemic to earthquakes: crisis-driven challenges in distance anatomy education | BMC Medical Education

This study examines the perspectives of health sciences vocational school students on distance anatomy education, focusing on their experiences, challenges, and preferences during the COVID-19 pandemic and the subsequent periods of online learning necessitated by the February 6, 2023, Kahramanmaraş-centered earthquakes. The findings highlight how these dual crises influenced the design and delivery of anatomy education, particularly in theoretical contexts where face-to-face interaction was severely limited.

The results are structured to address the research objectives, including the reliability and validity of the survey dimensions, the demographic characteristics of participants, and Comparative analyses across key factors such as motivation, the perceived importance of anatomy, accessibility, and the effectiveness of distance education. These findings provide valuable insights into the unique challenges and opportunities of distance anatomy education, particularly in regions affected by natural disasters such as the February 6, 2023, earthquakes, where online learning became a necessity rather than a choice.

Demographic data

This section presents an overview of the demographic characteristics of the participants, including gender, parental marital status, educational background, financial status, and regional distribution. These data are summarized in Tables 1 and 2, while the distribution of gender, department, and accommodation types is illustrated in Fig. 2.

A total of 748 students participated in the study, distributed across the programs as follows: Emergency and First Aid (20.1%), Home Patient Care (Day: 19.5%; Evening: 19.5%), Elderly Care (20.9%), and Anesthesia (20.1%). The majority of participants were female (67.8%), while 32.2% were male.

The highest proportion of participants reported that their parents had attained primary or secondary education, with 81.2% of mothers and 71.5% of fathers falling into this category. Similarly, most participants identified their financial status as “average” (71.0%).

In terms of geographic distribution, a substantial proportion of students resided in the Eastern Anatolia region (57.2%), followed by Southeastern Anatolia (36.2%). Accommodation data revealed that the majority of participants (67.0%) lived in state dormitories, while 33.0% lived at home or with family.

Reliability and validity analyses

The reliability and validity of the scales used in this study were assessed to ensure the accuracy and consistency of the results. Cronbach’s Alpha coefficients and exploratory factor analysis (EFA) were employed to evaluate these measures. The reliability Coefficients and item-specific analyses are presented in Table 3.

Cronbach’s Alpha values for the scales ranged from 0.646 to 0.878, indicating acceptable to high reliability. The Importance of Anatomy and Suggestions scale exhibited the highest reliability (α = 0.878), followed by Effectiveness of Distance Education (α = 0.869) and Motivation and Engagement (α = 0.791). These findings suggest that the scales used in the study provided consistent and reliable measurements for the factors evaluated.

Exploratory factor analysis confirmed the structural validity of the survey items. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was 0.858, indicating that the sample size was suitable for factor analysis. Bartlett’s test of sphericity (x²(378) = 2376.875, p < 0.05) further demonstrated that the Correlation matrix was suitable for identifying latent Constructs. EFA results revealed that the survey items loaded onto five distinct sub-factors, collectively explaining 59.23% of the total variance. These sub-factors included Importance of Anatomy and Suggestions, Effectiveness of Distance Education, Motivation and Engagement, Accessibility in Distance Education, and Sufficiency of Course Content.

These analyses confirm the psychometric robustness of the instrument, supporting its use for evaluating student perceptions of distance anatomy education.

Factor analysis results

Exploratory factor analysis (EFA) was conducted to assess the structural validity of the survey instrument and identify the underlying dimensions shaping students’ perceptions of distance anatomy education. The analysis identified five factors with eigenvalues exceeding 1, Collectively explaining 59.23% of the total variance. The percentage of variance explained by each factor is detailed in Table 4, demonstrating their individual and cumulative contributions to the model.

Factor contributions

• Importance of Anatomy and Suggestions emerged as the dominant factor, accounting for 25.00% of the variance. This factor includes items evaluating the perceived importance of anatomy education in clinical and professional contexts, such as its relevance to students’ academic programs and applicability to their future careers.

• The second factor, Effectiveness of Distance Education, explained 18.73% of the variance. Items within this factor assessed students’ evaluations of the overall quality and effectiveness of anatomy education delivered through distance learning, including the adequacy of teaching materials and comparisons with face-to-face instruction.

• Motivation and Engagement, the third factor, Contributed 5.60% to the total variance. This dimension encompasses students’ enthusiasm, willingness to participate in classes, and sense of progress throughout the course.

• The fourth factor, Accessibility in Distance Education, accounted for 5.35% of the variance. This factor highlights the ease of accessing course materials, live lectures, and recorded sessions, emphasizing the role of technological infrastructure in supporting student learning.

• The final factor, Sufficiency of Course Content, explained 4.53% of the variance. This dimension reflects students’ perceptions of the adequacy of the course content in meeting their academic and professional needs.

Factor loadings and interpretations

The factor loadings provided a detailed view of the structure and meaning of the five dimensions that emerged from the exploratory factor analysis. Each factor was defined by items with high loadings, which consistently reflected students’ perceptions of distance anatomy education and its role in vocational health training.

The Importance of Anatomy and Suggestions factor, which explained the largest proportion of variance, was primarily defined by items indicating that students regarded anatomy as an indispensable subject within their academic programs. High-loading items reflected strong agreement that the knowledge acquired in anatomy would be useful in future professional practice and that clinical knowledge provided in the course was directly relevant to their vocational training. This dimension demonstrated that students perceived anatomy not merely as a theoretical requirement but as essential knowledge forming the foundation of professional competence.

The Effectiveness of Distance Education factor was characterized by items emphasizing the adequacy and quality of teaching materials and instructional methods used during online delivery. Items with high factor loadings included statements regarding the preparedness of materials and the contribution of the YouTube channel to practical understanding. At the same time, responses highlighted skepticism regarding whether distance education could reach the same standard as face-to-face learning, indicating that although digital tools were considered supportive, they were not perceived as fully equivalent to traditional instruction.

The Motivation and Engagement factor reflected students’ enthusiasm for attending anatomy classes and their perception of progress over the semester. High-loading items demonstrated that students reported attending classes willingly and experienced a positive shift in their perspective toward anatomy. These results emphasize that motivation and engagement were sustained when students perceived the learning process as structured and meaningful, even in a distance education context.

The Accessibility in Distance Education factor was defined by items related to the ease of following live lessons and accessing recorded sessions. Students who reported no technical difficulties consistently rated their learning experiences more positively, whereas those who encountered access problems expressed reduced satisfaction. This dimension underscored the direct link between accessibility of online platforms and the perceived effectiveness of distance anatomy education.

Finally, the Sufficiency of Course Content factor was characterized by items assessing the adequacy of the course duration, content coverage, and its capacity to meet professional requirements. Responses reflected general satisfaction with the sufficiency of anatomy education when supported by digital resources such as videos, but also indicated that certain students perceived gaps, particularly in relation to practical training components.

In summary, the factor loadings confirmed the validity of the five identified dimensions and demonstrated that students’ perceptions of distance anatomy education were shaped by the combined influence of content adequacy, accessibility, motivation, effectiveness of delivery, and above all, the acknowledged importance of anatomy for professional development.

Descriptive statistics and response distributions

This section presents the descriptive statistics and response distributions of the survey items, offering an overview of students’ perceptions of anatomy education. Response distributions for all survey items are presented in Table 5, while response options are visually represented in Fig. 3. These statistics illustrate the central tendencies and variability of student responses across key dimensions such as motivation, importance of anatomy and suggestions, course sufficiency, accessibility, and effectiveness of distance education.

Within the Importance of Anatomy and Suggestions dimension, the majority of students agreed that anatomy is an essential subject in their programs and emphasized its relevance for their future professional roles. This indicates that, regardless of delivery format, anatomy retained its status as a core discipline in vocational health education.

Responses related to Motivation and Engagement demonstrated strong support for the inclusion of practical sessions in the curriculum. Many students emphasized that applied components would reinforce theoretical knowledge and sustain their interest in the subject, pointing to the continued importance of experiential learning opportunities.

In terms of the Effectiveness of Distance Education, the results were more heterogeneous. Students acknowledged the benefits of prepared materials and online resources; however, agreement with the view that distance education could fully replace face-to-face instruction was limited. Only a minority indicated a preference for anatomy courses to be conducted exclusively online, suggesting that distance education was generally perceived as complementary rather than substitutive.

Perceptions of the Sufficiency of Course Content were also varied. While many respondents considered the scope and duration of the course to be adequate, a considerable proportion either remained neutral or expressed reservations. This variation suggests that expectations regarding the comprehensiveness of anatomy instruction were not uniformly met.

Items addressing multimedia resources received consistently positive evaluations. The YouTube channel, which provided video-based demonstrations of anatomical structures and models, was regarded by most students as a motivating and helpful supplement to formal instruction. It was also frequently described as sufficient for supporting aspects of practical learning, especially under conditions where laboratory access was not possible.

Comparative tests: analysis of group differences

The Comparative analyses of student responses across demographic variables are presented in Tables 6, 7 and 8. Group differences were examined using Mann-Whitney U and Kruskal-Wallis tests, and only statistically significant findings are described below.

Departmental comparisons

Significant differences were identified in the Motivation and Engagement dimension (χ² = 21.132, p < 0.001). Students enrolled in the Home Patient Care (day program) reported higher levels of motivation compared with those in the Emergency and First Aid program. Additional pairwise comparisons indicated that Elderly Care students also demonstrated higher motivation than Emergency and First Aid students, while Anesthesia students scored lower than their Home Patient Care (day program) peers. These results suggest that motivation toward anatomy may vary according to how directly students perceive the subject to be linked with their vocational practice.

Gender-based differences

A significant difference was observed in the Effectiveness of Distance Education scale (Z = − 2.006, p = 0.045), where male students rated online anatomy instruction more favorably than female students. No statistically significant differences were identified between genders in the remaining dimensions, including Motivation and Engagement or Accessibility.

Accommodation type

Accommodation type was associated with significant differences in both Effectiveness of Distance Education (Z = − 2.835, p = 0.005) and Accessibility (Z = − 1.982, p = 0.048). Students living in state dormitories reported lower levels of perceived effectiveness and accessibility compared with those living at home or with family. No significant differences were observed for the other scales.

In summary, departmental affiliation, gender, and accommodation type were found to influence specific perceptions of distance anatomy education. Motivation was highest among Home Patient Care students, male students expressed relatively greater confidence in the effectiveness of distance education, and dormitory residents experienced more difficulties with access and perceived effectiveness than students residing at home.

Correlation analysis

The Correlation analysis presented in Table 9 examined the relationships between the five key scales in anatomy education. The results are also illustrated as a heatmap in Fig. 4. Statistically significant correlations were observed between most scales, with varying strengths and directions.

A moderate positive correlation was found between Importance of Anatomy and Suggestions and Motivation and Engagement (r = 0.405, p < 0.001), suggesting that students who perceived anatomy as more relevant to their academic and professional development also demonstrated higher levels of motivation. In contrast, a weak negative correlation was observed between Importance of Anatomy and Effectiveness of Distance Education (r = − 0.197, p = 0.009), indicating that students who strongly valued anatomy did not necessarily regard distance instruction as effective.

The strongest relationship was identified between Effectiveness of Distance Education and Accessibility (r = 0.509, p < 0.001). Students who reported fewer difficulties in accessing online content were more likely to evaluate distance anatomy education as effective. Additionally, Effectiveness was moderately correlated with Sufficiency of Course Content (r = 0.370, p < 0.001), suggesting that perceptions of well-structured content contributed to the perceived quality of distance learning.

Accessibility also showed moderate positive correlations with both Motivation and Engagement (r = 0.447, p < 0.001) and Sufficiency of Course Content (r = 0.379, p < 0.001). These results indicate that students who could reliably access materials were both more motivated and more satisfied with the adequacy of course content.

Finally, Motivation and Engagement correlated positively with Sufficiency of Course Content (r = 0.346, p < 0.001), highlighting that students who considered the course content sufficient were more likely to report sustained motivation throughout the semester.

Taken together, the correlation results demonstrate that students’ perceptions of distance anatomy education were strongly influenced by the interplay between accessibility, content sufficiency, motivation, and effectiveness, with accessibility emerging as the most critical factor in shaping positive evaluations.