A total of 13 focus group discussions were conducted with 86 participants (male = 36, female = 50). The age of the students ranged from 19 to 22 (20 ± 1.2) years. The distribution of residency was 8 for rural areas, 37 for low density, 20 for medium density and 21 for high density. Table 1 below shows the distribution of study participants by sex, residence area, learning institution and academic year.
Cognitive regulation
Organizing and transforming
Most students who participated in the focus group discussions reported self-initiated rearrangement of instructional materials to improve learning. These students said that they recapped the objectives of each class and then grouped related information for easy understanding during lockdown learning. For example, one student mentioned that: “I normally just prefer listing down related information as well as tabulating differences so that my studying is neater” (#20, M, 22). Another student agreed: “I can list down structures found at every significant vertebral level” (#5, F, 21).
The majority of the students also compressed information into short notes. However, a minority struggled to organize learned information due to their fears of capturing incorrect information in the process and inadequate time to do so. A student in this group that struggled to organize learned information noted: “I do not usually organize my study because at the end of the day I am supposed to know everything, and with the vast of information and little time we have it is difficult” (#79, M, 22).
The use of an atlas alongside reading anatomy textbooks was noted by some students, as they claimed that it fills the gap that the dissection room was supposed to fill. Atlases helped visualize the information as well as used to annotate lecture content. A female student quipped that: “My atlas textbook is almost like my dissection cadaver at home” (#11, F, 22). Another reported that she uses the atlas reduce lecture content by “annotating lecturer notes on the pictures in the atlas” (#30, F, 22). A greater fraction of students from both universities reported that organizing their anatomy study and content while studying the subject at home was rewarding.
Rehearsing and memorizing
In their study of anatomy during the COVID-19 lockdown while at their respective homes, the students gave statements indicating self-initiated efforts to memorize material by overt or covert practice indicating that they employed a great deal of memorization and rehearsing. Almost all the students reported using this strategy frequently and in several ways. The majority of the students used commonly known mnemonics, while others preferred homemade mnemonics derived from common words in their home environment, such as the names of pets (#12, M, 20), siblings (#41, F, 20) and friends (#16, F, 21) For example, a commonly used strategy was captured by one student who noted the following: “I find mnemonics being the fast and easy way to bring back information, especially in an exam setting, because large sets of information are generally compressed to common words or statements” (#7, F, 21).
A minority of the students were not using mnemonics as they claimed to be “extra work” but used other techniques instead, such as “reproducing concepts through discussions with classmates” (#62, M, 22), “homemade notes” (#50, F, 19) and “self-initiated rehearsal sessions” (#33, F,23). One such student captured this as follows: “I might end up having a mini textbook for mnemonics, so it is better that I understand the concept only” (#02, M, 20).
Instead of mnemonics and self-study, a larger fraction of students who participated in the focus group discussions resorted to doing “mock presentations of the anatomy content” (#09, M, 22) that they would have learned to each other via the WhatsApp platform despite the challenges of electricity and internet access. The remainder reported not doing so because of “internet access problems and prohibitive costs” (#76, F, 21), especially those who were residing in remote and high-density areas during the lockdown period. These students, however, utilized their family members by conducting mock lecturing sessions just to help them recall the anatomy they would have learned or been reading from textbooks. For instance, one student quipped: “I teach my mom or sister, even though they don’t understand it, but it helps me remember.” (#22, F, 20).
The majority of the students also used paper as well as soft copy “flashcards” (#70, M, 21) that have “questions, short statements, and reminders that they would stick on several places in their homes”. The students reported that they found it challenging to memorize structures and relations without dissection, so they used atlases such as Gray’s Atlas of Anatomy and Netter’s Essential Histology for both gross anatomy and histology, respectively. In addition, they said it was easier to recall a photographic image than written statements. Some students preferred using their artistic abilities to draw anatomical structures as part of their memorizing.
Meta-cognitive regulation
Self-evaluation
Self-evaluation during the lockdown was necessary for the anatomy students to keep themselves in check to effectively monitor their study habits. The whole sample of students who participated in the focus group discussions showed self-initiated evaluation of the quality and progress of their work in different ways. The majority revised anatomy using multiple choice questions (MCQs) obtained from several internet anatomy sites. They also set their own questions before and after the study to check their progress. Many students echoed the following sentiment of one student: “I find MCQs being the most useful tool to evaluate my study because they indicate areas of weakness to me” (#44, M, 23).
The students also “wrote notes from memory and compared them with the anatomy textbook” (#47, M, 21) to show them how much information they obtained from their study. Some students also utilized their peers using online platforms such as WhatsApp during the discussions to see how much they were lacking in comparison to other students. The following statement by one student received concurrence from the majority of the group members during discussions: “My discussion group helps me see where I am, relative to others, and then I know the amount of effort that I need to put in later on” (#45, F, 20). However, some students reported facing challenges in carrying out such as a “lack of a reliable internet connection” (#54, M, 22) as well as “failing to synchronize the lockdown-era learning schedule” (#38, F, 21) and peers’ free time with “household chores” (#65, F, 21). For instance, one said: “It is hard to constantly have discussions at a fixed (time) because anyone can get caught up with anything at any time” (#19, F, 20).
Some students reported resorting to “spaced repetition and retrieval” (#80, M, 21) in which they repeated anatomical information over spaced intervals to remember and judge how much they remember.
Goal setting and planning
The majority of the students reported that they were able to set goals and plans for sequencing, timing, and completing activities related to learning anatomy during the lockdown. However, a minority of students reported having “less time to fulfil the set goals” (#64, M, 20). They reported that the home environment, especially in high-density areas, did not have space for effective study undisturbed, while others, especially females, noted that “household chores” (#77, F, 21) assigned to them at home made it hard to set goals, plan and follow them. They were demotivated to continue with meticulous goal setting such that they ended up stopping carrying out study plans over time. Both male and female students reported similar patterns of goal setting and work planning.
Some students chose to balance their attention on all courses instead of just anatomy during the lockdown period. However, they largely admitted that anatomy is challenging, leading to the subject receiving more attention than others, as captured below:
“I plan to spend 60% of my week’s study time reading anatomy because it is tough and then divide the rest into other courses” (#37, M. 22).
“I draft timetables because they prevent the overlapping of Anatomy study into sessions for other courses” (#03, M, 20).
Female students highlighted experiencing more disruptions to their set goals due to disproportionate participation in household chore compared to their male counterparts. For example:
“It’s hard to plan and set goals knowing that there are high chances of not being able to achieve them with all disturbances at home” (#84, F, 19).
“It is hard to follow timetables when at home… being a woman at home you get to perform most of the duties such as cleaning, cooking, laundry and taking care of younger children, something male members of the family do not do, I guess it’s the culture” (#57, F, 21).
Overall, studying from home during the COVID-19-induced lockdown was generally viewed as challenging, with female students being affected more due to the patriarchal home environment as well as the skewed nature of the distribution of numerous “household duties falling on women” (#26, F, 20).
Keeping/reviewing records and monitoring anatomy learning during lockdown
Most of the students reported keeping records of the anatomy information they learned in many different forms for future use. However, a few focus group discussants did not keep records due to the challenges of revisiting citing the “heavy workload and limited time” (#14, M, 22) during the lockdown. The majority of such students were male.
The widely used record-keeping method was “note-taking during online lectures” (#13, M, 20) and when studying. Many students felt that this method helps them to boost their focus, as explained below: “I wrote some notes to keep myself motivated during studying, and I wrote down everything I got wrong in an exam to work on them as objectives.”
Other records were kept in form of “short notes” (#66, F, 20), “flashcards” (#18, F, 20), audio and even videos. Modifying the notes was done in successive study sessions as the students added more information. A small fraction of anatomy learners found it challenging to keep records, as they never had enough time to revisit them due to ever-increasing workloads and other competing needs in the home environment. One such student quipped: “It’s hard to write notes that you know you will never read them again in such pressure-filled times.” (#10, M, 21).
Reviewing handwritten notes, textbooks, and MCQs were widely used by the majority of the students. Many students reported that reviewing past MCQs was an effective tool in evaluating their level of learning and understanding as well as exam preparation and was mostly used by second-year anatomy students as shown below.
“I revise MCQs with my (handwritten) notes and also revisit the anatomy textbooks” (#07, F, 22).
“In the first year, I relied more on the textbook to prepare for anatomy examinations, but now I do MCQs then discuss with peers.” (#30, F, 22).
On the other hand, a minority reported that using MCQs just before exams increased panic and anxiety as exemplified by: “I cannot use MCQs just before an anatomy exam because I may panic by seeing several questions whose answers I do not know” (#41, F, 20).
Most students did not review textbooks before exams due to their large volumes of information in a short period, hence the use of notes, audio, YouTube videos and flashcards, but could do so in preparation for a discussion group with classmates.
Effort regulation
Environmental structuring
Effort regulation refers to the student’s ability to continue performing a task even when faced with inherent difficulties [44]. The majority of students who participated in the focus group discussions portrayed how they managed their anatomy studies on their own in different environments during the lockdown. Some students residing in high-density suburbs and rural areas had “trouble finding a conducive study environment” (#71, M, 20), with most of them resorting to studying at night when most family members are asleep, as captured by some below:
“I need to check what my environment is like before I sit to study” (#61, F, 19).“It is hard to find a quiet place unless, during night time, that is why I study during the night” (#25, M, 22).
On the other hand, a few students who stayed in low-density suburbs that provided a quiet, clean and isolated environment during lockdown could not care much about the state of the surroundings for studying anatomy, as one noted below:
“I am not much affected by my environment at home” (#54, M, 22).
However, studying at new places was found to be “motivating” (#85, F, 21); hence, some students rotated around their homes trying to find suitable places to study anatomy during the lockdown. The use of music during the study was noted by some students as an effective tool to support effort regulation, while some students opted for “total silence for maximum concentration” (#23, F, 20).
Self-consequences
Statements indicating self-initiated imagination of rewards or punishment for success or failure to achieve self-set goals were noted in approximately half of the focus group discussions participants. Many students reported rewarding themselves more than punishment, as they felt that there was no need to punish themselves if the “workload was already heavy” (#73, M, 19). Those who rewarded themselves did so by temporarily stopping reading for a while to gain motivation, spending time with the family, watching television, surfing the internet and visiting social media. For example:
“I feel like my end goal is to pass exams so better I motivate myself by constant rewards than punishments” (#33, F, 23).
A few students punished themselves by depriving themselves of social media, friends, and family time until a specific task was completed. Other students never used any of the two strategies, as they said that passing is the reward and studying hard is the price for it.
“I am punished and rewarded by my result on the exam results noticeboard, so I don’t do it myself” (#49, F, 21).
Resource management
Seeking social assistance (elder, teacher and tutor, peers)
All students who participated in the focus group discussions reported seeking educational assistance from either an elder/mentor in medical school, a lecturer, a tutor, or peers. Most students mentioned being uncomfortable seeking assistance from their lecturers but could frequently approach their tutors (BSc intercalated anatomy students) instead:
“I find it hard to text my lecturer so I usually pass my question to the tutors” (#65, F, 21).
The use of mentors/elders, especially those who are streams ahead, was noted, as students preferred someone who once studied anatomy and understands for emotional support:
“Parents and friends were necessary for emotional support, as students needed constant mental support during the pandemic.” (#01, F, 22).
The majority of students showed that the assistance that comes from a peer was very helpful. This was noted as many students raised the issue of discussion groups being the best learning platform at all times, especially toward Anatomy exams”.
“… my discussion group is almost my everything from academic to emotional support because we are in the same boat and we face everything together.” (#40, M, 22).
Team work was a very useful tool in anatomy studies during the pandemic season, as the students stayed connected in their work and discussions through social media.
Seeking information
The ability to search for information from several online sources was important in studying anatomy during the lockdown, where the student had to hunt for the source of information to keep up with the subject content and everyone else. The majority of students looked for information mostly online through Google searches, retrieving uploaded videos, and classmates.
“I go online to check textbooks, notes and videos to try and understand more about what I know already” (#58, M, 21).
Some students preferred to search for other texts online just to remain motivated on the subject. Social media platforms such as WhatsApp were used more commonly to ask for books, notes, videos, recordings and extra sources of anatomical information from colleagues. A few students preferred sticking to the recommended anatomy textbooks to minimize confusion between texts as well as because of the limited time.
“I already have no time to finish up all the anatomy books. So, why do l have to fish for other books?” (#72, F, 20).
However, a considerable number of students reported facing “poor internet connectivity” in some areas of Zimbabwe, as almost all the accessible sources for anatomy during remote learning were available online. This was captured by representative students, one lived in a rural setting and another in a medium density suburb:
“in my rural environment, the network boosters are far apart and mobile internet connectivity was very poor and often offline whenever there was no ZESA (electricity)” (#63, M, 20).
“I lived in the city but with frequent power outages and expensive broadband internet activity, sometimes the only time I could access mobile internet to study would very late in the night” (#29, F, 22).
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