The cognitive and psychosocial effects of online learning in medical students during and after the COVID-19 pandemic: a mixed-methods study from Karachi, Pakistan

Background: The COVID-19 pandemic precipitated a swift shift towards e-learning platforms in medical education. While research has predominantly concentrated on evaluating the efficacy and obstacles associated with online learning, the cognitive and psychosocial dimensions within medical education remain largely underexplored. Methods: A mixed-methods explanatory sequential study was conducted from July 2021 to February 2022 amongst medical students engaged in online learning for at least six months in Karachi, Pakistan. In this study, participating medical students were requested to reflect on their experiences with and perceptions of online learning during and after the pandemic. The quantitative phase of the study involved a digital questionnaire, while the qualitative phase of the study employed semi-structured focus group discussions (FGDs). Quantitative data were summarized using descriptive statistics and categorical associations were statistically tested using Pearson’s chi-squared (X²) test. The transcribed FGDs were coded using a scissors-and-sort technique and qualitatively summarized in a narrative fashion and in descriptive memoranda. Results: A total of 262 students were included in the quantitative arm of the study (of whom 18 were included in the qualitative arm). 46.9% of the students were males, 51.1% were pre-clinical students, and 13.4% belonged to universities aside from Aga Khan University. Participating students reported that their academic screen time rose dramatically during the COVID-19 pandemic, with 80.5% spending over 3 h on screens, compared to 52.3% engaging for less than 1 h pre-pandemic. Online learning showed significant gender-based impacts: male students felt less engaged (p = 0.007), while female students reported less motivation (p = 0.007) and anxiety reduction (p = 0.042). Duration of online exposure influenced outcomes; students with less screen time for learning reported better self-regulation (p = 0.019), whereas higher entertainment screen time correlated with poorer achievement of learning objectives (p = 0.019). Pre-clinical students reported that they faced more challenges with engagement (p = 0.038), but were less likely to feel exhausted (p = 0.001) or have trouble paying attention during online studies than their clinical counterparts (p = 0.007). Overall, while some students highlighted the efficiency and convenience of online learning, many observed that they experienced increased distraction and isolation, suggesting a mixed impact on educational outcomes. Conclusion: Online medical education offers opportunities and challenges, with our results suggesting clear cognitive and psychosocial effects. Balancing student needs with hybrid learning methods is necessary to implement online learning pedagogies effectively.