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Khaleghi M M, Momeni K, Boostanizadeh H, Ebrahimi A. (2025). The role of attitude towards relationship education on learning anxiety and academic burnout in students of Bushehr University of Medical Sciences in 2022. refahj. 25(97), : 4 doi:10.32598/refahj.25.97.4346.1
URL: http://refahj.uswr.ac.ir/article-1-4204-en.html
URL: http://refahj.uswr.ac.ir/article-1-4204-en.html
Keywords: academic burnout, attitude towards virtual education, learning anxiety, students, e-learning
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Extended Abstract
Introduction
Nowadays, virtual education is proposed as a new model in teaching and learning (Karimian & Farokhi 2018). In recent years, some medical universities have offered courses virtually, but the sudden outbreak of COVID-19 led to a full shift from in-person to virtual training to ensure safety and social distancing (Bender, 2020; Khosravi. et al., 2021). Virtual education offers flexibility and reduces the need for costly travel, but it may lead to weaker human interactions and increased student anxiety. Inadequate infrastructure, like limited internet bandwidth, also reduces the efficiency of virtual learning (Shahbeigi & Nazari, 2012) . The shift to virtual education poses significant challenges for higher education (Sadeghitabar & Shariatmadari, 2021) .In teaching and learning processes, anxiety is very common (Setianingsih et al., 2019) . Increased anxiety lowers students’ academic performanc (Ren et al., 2021) . Academic burnout is a major educational challenge that undermines performance and wastes resources across all education levels (Korani, 2021). Academic burnout results from prolonged exposure to academic stress and can become persistent if sustained over tim .(Falahchai et al., 2020) . This study uniquely explores the relationship between attitude toward virtual education, learning anxiety, and academic burnout among medical students in Bushehr in 2022. Its significance lies in examining these variables together across diverse educational levels and disciplines, using a distinct methodology and setting.
Method
This cross-sectional descriptive-analytical study was conducted on all students of Bushehr University of Medical Sciences during the 2021-2022 academic year. A sample of 331 students was selected using simple random sampling. After coordination with the university’s education vice-chancellor and obtaining the student list, samples were identified by lottery. Inclusion criteria were enrollment at the university and willingness to participate; exclusion criteria included neurological, mental, or physical illnesses affecting results, withdrawal from participation, incomplete questionnaires, or excessive missing data. Standardized educational content was delivered virtually in two sessions via CD by the relevant instructor. In the following session, after explaining the study’s objectives and importance, students completed four questionnaires covering demographic information, attitude toward virtual education (Vatanparast et al.), learning anxiety (Pekran), and academic burnout (Berso et al.). Data were analyzed using SPSS version 22.
Findings
The findings show that the mean and standard deviation of the variable total score of the attitude towards virtual education were 3.18 and 0.80, respectively. So that 56.2% of the participants had a positive attitude towards virtual education. The results of the mean and standard deviation of learning anxiety showed 32.86 and 9.87, respectively. After examining learning anxiety in three levels, it was seen that 13.9% of the participants had a low level, 38.1% had an average level, and 48% of them had a high level of learning anxiety. The mean and standard deviation of the total score in academic burnout were 39.93 and 8.47, respectively.
As mentioned in Table, the results related to the relationship between learning anxiety and academic burnout showed an inverse significant relationship (p-value <0.05). This means that the less students have learning anxiety, the more academic burnout they experience. (p-value>0.05).
Discussion
Approximately half of the participants expressed a positive attitude toward virtual education. While 86.1% reported moderate to high levels of learning anxiety, no significant association was found between their attitude toward virtual education and the level of learning anxiety.
A study conducted by Javanmard et al. in 2020 showed that a positive attitude towards virtual education was not associated with increased learning anxiety (Javanmard et al., 2020). This suggests that attitudes toward virtual education are not always directly linked to learning anxiety, as other contributing factors may be involved. However, when virtual education is delivered with high quality, a positive attitude can help reduce learning anxiety. (Kuo, 2020).
The results of Tahani al-Shammari’s study also showed that most students have anxiety when the training is a combination of face-to-face and virtual (Alshammari et al., 2022). In Lebanon, Fawaz and Samaha found that virtual education hindered student learning and contributed to anxiety, stress, and depression among undergraduate students (Fawaz & Samaha, 2021). Also, the research results of Najmul Haq et al showed that about 82.5% of undergraduate students in Bangladesh experience mild to severe anxiety during virtual training (Hoque et al., 2021). Differences in study results may stem from variations in virtual education quality, students’ prior experiences, cultural backgrounds, and environmental conditions.
The overuse of digital technology in post-pandemic education has introduced digital health risks linked to academic burnout among students (Song et al., 2022). In our study, all students experienced some level of academic burnout, though no significant link was found with attitudes toward virtual education. In contrast, Soltani et al. (2021) reported that a positive attitude may reduce burnout, particularly when students benefit from quality virtual learning experiences (Soltani & Andrade, 2021).
Hosseini’s study showed that virtual education effectively reduced academic burnout among high school female students (Fahraji, 2021). The results of another study showed that there is a positive correlation between medical students’ stress and academic burnout in the field of online learning (Liu & Cao, 2022). On the other hand, other studies also state that there is a positive relationship between anxiety and academic burnout (He et al., 2018; Yu et al., 2021), In contrast to other studies, our findings showed that students with lower learning anxiety experienced higher academic burnout. This discrepancy may be influenced by social and environmental factors, as Chunming et al. found that elements like social support and student environments significantly affect academic burnout (Chunming et al., 2017). In another study titled academic burnout among undergraduate students during extensive online learning, the results showed that 28.4% of 7562 participants had academic burnout (Zhu et al., 2022).
Ethical considerations
Contribution of authors
All authors contributed to this article.
Financial Resources
No financial support was received from any person or organization for this article.
Conflict of interest
The authors have stated that there is no conflict of interest.
Following the ethical principles of research
In the present study, all ethical considerations, including the conditions of trustworthiness, honesty and non-plagiarism, have been observed.
Reference:
Alshammari, T., Alseraye, S., Alqasim, R., Rogowska, A., Alrasheed, N., & Alshammari, M. (2022). Examining anxiety and stress regarding virtual learning in colleges of health sciences: A cross-sectional study in the era of the COVID-19 pandemic in Saudi Arabia. Saudi Pharmaceutical Journal, 30(3), 256-264. doi: https://doi.org/10.1016/j.jsps.2022.01.010
Bender, L. (2020). Interim Guidance for COVID-19 Prevention and Control in Schools. Retrieved from https://files.eric.ed.gov/fulltext/ED604378.pdf
Chunming, W. M., Harrison, R., MacIntyre, R., Travaglia, J., & Balasooriya, C. (2017). Burnout in medical students: a systematic review of experiences in Chinese medical schools. BMC medical education, 17(1), 1-11. https://doi.org/10.1186/s12909-017-1064-3
Fahraji, M. S. H. (2021). Determining the effectiveness of virtual education on academic burnout and creativity in female high school students in Yazd. Quarterly magazine of new developments in educational management, 2(4), 87-94.
Fawaz, M., & Samaha, A. (2021). E‐learning: Depression, anxiety, and stress symptomatology among Lebanese university students during COVID‐19 quarantine (Vol. 56): Wiley Online Library. https://doi.org/10.1111/nuf.12521
Falahchai, M., Taheri, M., Neshandar Asli, H., Babaee Hemmati, Y., & Pourseyedian, S. (2020). A Survey of the Relationship between Academic Burnout and Academic Achievement of Dental Students of Guilan University of Medical Sciences. Research in Medical Education, 12(4), 70-79. .(in Persian)http://rme.gums.ac.ir/article-1-943-en.html
He, A. S., Phillips, J. D., Lizano, E. L., Rienks, S., & Leake, R. (2018). Examining internal and external job resources in child welfare: Protecting against caseworker burnout. Child Abuse & Neglect, 81, 48-59. https://doi.org/10.1016/j.chiabu.2018.04.013
Hoque, M. N., Hannan, A., Imran, S., Alam, M. A., Matubber, B., & Saha, S. M. (2021). Anxiety and Its Determinants among Undergraduate Students during E-learning in Bangladesh Amid Covid-19. J Affect Disord Rep, 6, 100241. https://doi.org/10.1016/j.jadr.2021.100241
Javanmard, H., Baharmoghadam, M., & Moradi, Z. (2020). The quality of virtual education during the covid-19 epidemic in public universities (case study: graduate students of Shahid Bahonar University, Kerman). New research approaches in management and accounting, 84(6), 2274-2291. (in Persian)
Karimian, Z., & Farokhi, m. (2018). Eight steps of virtual education development in the transformation and educational innovation plan of universities of medical sciences, a review of an experience. Journal of medicine and cultivation, 27(2), 101-112.
Khosravi.A, Lotfi, F., Yazdankhah.M, & Mirzaee, K. (2021). Evaluation of the views of undergraduate students in the field of medical librarianship and information of medical sciences universities of the country on the status of virtual education of students in 1400. Health Information Management, 18(4), 166-171. (in Persian). https://doi.org/10.22122/him.v18i4.4385
Korani, Z. (2021). The Relationships Self-Efficacy On Academic Burnout Among Students In Razi University. Education Strategies in Medical Sciences, 14(1), 23-34. (in Persian)
Kuo, T.-T. (2020). The anatomy of a distributed predictive modeling framework: online learning, blockchain network, and consensus algorithm. JAMIA open, 3(2), 201-208. https://doi.org/10.1093/jamiaopen/ooaa017
Liu, Y., & Cao, Z. (2022). The impact of social support and stress on academic burnout among medical students in online learning: The mediating role of resilience. Front Public Health, 10, 938132. https://doi.org/10.3389/fpubh.2022.938132
en, Z., Xin, Y., Ge, J., Zhao, Z., Liu, D., Ho, R. C., & Ho, C. S. (2021). Psychological impact of COVID-19 on college students after school reopening: a cross-sectional study based on machine learning. Frontiers in Psychology, 12, 641806. https://doi.org/10.3389/fpsyg.2021.641806
Sadeghitabar, P., & Shariatmadari, M. (2021). Identification of the Dimensions and Components of Continuing Medical Education Based on Blended Learning with Sustainable Development Approach. Environmental Education and Sustainable Development, 9(2), 63-82. (in Persian) https://doi.org/10.30473/ee.2021.7537
Setianingsih, T. Y., Wiyatno, A., Hartono, T. S., Hindawati, E., Dewantari, A. K., Myint, K. S.,... Safari, D. (2019). Detection of multiple viral sequences in the respiratory tract samples of suspected Middle East respiratory syndrome coronavirus patients in Jakarta, Indonesia 2015–2016. International Journal of Infectious Diseases, 86, 102-107. https://doi.org/10.1016/j.ijid.2019.06.022
Shahbeigi, F., & Nazari, S. (2012). Virtual education: Benefits and limitations. The Journal of Medical Education and Development, 6(1), 47-54. (in Persian)
Soltani, P., & Andrade, R. (2021). The influence of virtual reality head-mounted displays on balance outcomes and training paradigms: a systematic review. Frontiers in sports and active living, 2, 531535. https://doi.org/10.3389/fspor.2020.531535
Song, W., Wang, Z., & Zhang, R. (2022). Classroom Digital Teaching and College Students’ Academic Burnout in the Post COVID-19 Era: A Cross-Sectional Study. Int J Environ Res Public Health, 19(20). doi:10.3390/ijerph192013403. https://doi.org/10.3390/ijerph192013403
Yu, A., Wilkes, M., & Iosif, A.-M. (2021). Exploring the Relationships Between Resilience and News Monitoring with COVID Distress. Academic Psychiatry, 45(5), 566-574. https://doi.org/10.1007/s40596-021-01444-9
Zhu, K., Xie, X., Liu, Q., Meng, H., & Song, R. (2022). Internet addiction: Prevalence and relationship with academic burnout among undergraduates during widespread online learning. Perspect Psychiatr Care, 58(4), 2303-2309. doi:https://doi.org/10.1111/ppc.13060
Introduction
Nowadays, virtual education is proposed as a new model in teaching and learning (Karimian & Farokhi 2018). In recent years, some medical universities have offered courses virtually, but the sudden outbreak of COVID-19 led to a full shift from in-person to virtual training to ensure safety and social distancing (Bender, 2020; Khosravi. et al., 2021). Virtual education offers flexibility and reduces the need for costly travel, but it may lead to weaker human interactions and increased student anxiety. Inadequate infrastructure, like limited internet bandwidth, also reduces the efficiency of virtual learning (Shahbeigi & Nazari, 2012) . The shift to virtual education poses significant challenges for higher education (Sadeghitabar & Shariatmadari, 2021) .In teaching and learning processes, anxiety is very common (Setianingsih et al., 2019) . Increased anxiety lowers students’ academic performanc (Ren et al., 2021) . Academic burnout is a major educational challenge that undermines performance and wastes resources across all education levels (Korani, 2021). Academic burnout results from prolonged exposure to academic stress and can become persistent if sustained over tim .(Falahchai et al., 2020) . This study uniquely explores the relationship between attitude toward virtual education, learning anxiety, and academic burnout among medical students in Bushehr in 2022. Its significance lies in examining these variables together across diverse educational levels and disciplines, using a distinct methodology and setting.
Method
This cross-sectional descriptive-analytical study was conducted on all students of Bushehr University of Medical Sciences during the 2021-2022 academic year. A sample of 331 students was selected using simple random sampling. After coordination with the university’s education vice-chancellor and obtaining the student list, samples were identified by lottery. Inclusion criteria were enrollment at the university and willingness to participate; exclusion criteria included neurological, mental, or physical illnesses affecting results, withdrawal from participation, incomplete questionnaires, or excessive missing data. Standardized educational content was delivered virtually in two sessions via CD by the relevant instructor. In the following session, after explaining the study’s objectives and importance, students completed four questionnaires covering demographic information, attitude toward virtual education (Vatanparast et al.), learning anxiety (Pekran), and academic burnout (Berso et al.). Data were analyzed using SPSS version 22.
Findings
The findings show that the mean and standard deviation of the variable total score of the attitude towards virtual education were 3.18 and 0.80, respectively. So that 56.2% of the participants had a positive attitude towards virtual education. The results of the mean and standard deviation of learning anxiety showed 32.86 and 9.87, respectively. After examining learning anxiety in three levels, it was seen that 13.9% of the participants had a low level, 38.1% had an average level, and 48% of them had a high level of learning anxiety. The mean and standard deviation of the total score in academic burnout were 39.93 and 8.47, respectively.
As mentioned in Table, the results related to the relationship between learning anxiety and academic burnout showed an inverse significant relationship (p-value <0.05). This means that the less students have learning anxiety, the more academic burnout they experience. (p-value>0.05).
Table: Relationship between attitude towards virtual education, academic burnout and learning anxiety
Discussion
Approximately half of the participants expressed a positive attitude toward virtual education. While 86.1% reported moderate to high levels of learning anxiety, no significant association was found between their attitude toward virtual education and the level of learning anxiety.
A study conducted by Javanmard et al. in 2020 showed that a positive attitude towards virtual education was not associated with increased learning anxiety (Javanmard et al., 2020). This suggests that attitudes toward virtual education are not always directly linked to learning anxiety, as other contributing factors may be involved. However, when virtual education is delivered with high quality, a positive attitude can help reduce learning anxiety. (Kuo, 2020).
The results of Tahani al-Shammari’s study also showed that most students have anxiety when the training is a combination of face-to-face and virtual (Alshammari et al., 2022). In Lebanon, Fawaz and Samaha found that virtual education hindered student learning and contributed to anxiety, stress, and depression among undergraduate students (Fawaz & Samaha, 2021). Also, the research results of Najmul Haq et al showed that about 82.5% of undergraduate students in Bangladesh experience mild to severe anxiety during virtual training (Hoque et al., 2021). Differences in study results may stem from variations in virtual education quality, students’ prior experiences, cultural backgrounds, and environmental conditions.
The overuse of digital technology in post-pandemic education has introduced digital health risks linked to academic burnout among students (Song et al., 2022). In our study, all students experienced some level of academic burnout, though no significant link was found with attitudes toward virtual education. In contrast, Soltani et al. (2021) reported that a positive attitude may reduce burnout, particularly when students benefit from quality virtual learning experiences (Soltani & Andrade, 2021).
Hosseini’s study showed that virtual education effectively reduced academic burnout among high school female students (Fahraji, 2021). The results of another study showed that there is a positive correlation between medical students’ stress and academic burnout in the field of online learning (Liu & Cao, 2022). On the other hand, other studies also state that there is a positive relationship between anxiety and academic burnout (He et al., 2018; Yu et al., 2021), In contrast to other studies, our findings showed that students with lower learning anxiety experienced higher academic burnout. This discrepancy may be influenced by social and environmental factors, as Chunming et al. found that elements like social support and student environments significantly affect academic burnout (Chunming et al., 2017). In another study titled academic burnout among undergraduate students during extensive online learning, the results showed that 28.4% of 7562 participants had academic burnout (Zhu et al., 2022).
Ethical considerations
Contribution of authors
All authors contributed to this article.
Financial Resources
No financial support was received from any person or organization for this article.
Conflict of interest
The authors have stated that there is no conflict of interest.
Following the ethical principles of research
In the present study, all ethical considerations, including the conditions of trustworthiness, honesty and non-plagiarism, have been observed.
Reference:
Alshammari, T., Alseraye, S., Alqasim, R., Rogowska, A., Alrasheed, N., & Alshammari, M. (2022). Examining anxiety and stress regarding virtual learning in colleges of health sciences: A cross-sectional study in the era of the COVID-19 pandemic in Saudi Arabia. Saudi Pharmaceutical Journal, 30(3), 256-264. doi: https://doi.org/10.1016/j.jsps.2022.01.010
Bender, L. (2020). Interim Guidance for COVID-19 Prevention and Control in Schools. Retrieved from https://files.eric.ed.gov/fulltext/ED604378.pdf
Chunming, W. M., Harrison, R., MacIntyre, R., Travaglia, J., & Balasooriya, C. (2017). Burnout in medical students: a systematic review of experiences in Chinese medical schools. BMC medical education, 17(1), 1-11. https://doi.org/10.1186/s12909-017-1064-3
Fahraji, M. S. H. (2021). Determining the effectiveness of virtual education on academic burnout and creativity in female high school students in Yazd. Quarterly magazine of new developments in educational management, 2(4), 87-94.
Fawaz, M., & Samaha, A. (2021). E‐learning: Depression, anxiety, and stress symptomatology among Lebanese university students during COVID‐19 quarantine (Vol. 56): Wiley Online Library. https://doi.org/10.1111/nuf.12521
Falahchai, M., Taheri, M., Neshandar Asli, H., Babaee Hemmati, Y., & Pourseyedian, S. (2020). A Survey of the Relationship between Academic Burnout and Academic Achievement of Dental Students of Guilan University of Medical Sciences. Research in Medical Education, 12(4), 70-79. .(in Persian)http://rme.gums.ac.ir/article-1-943-en.html
He, A. S., Phillips, J. D., Lizano, E. L., Rienks, S., & Leake, R. (2018). Examining internal and external job resources in child welfare: Protecting against caseworker burnout. Child Abuse & Neglect, 81, 48-59. https://doi.org/10.1016/j.chiabu.2018.04.013
Hoque, M. N., Hannan, A., Imran, S., Alam, M. A., Matubber, B., & Saha, S. M. (2021). Anxiety and Its Determinants among Undergraduate Students during E-learning in Bangladesh Amid Covid-19. J Affect Disord Rep, 6, 100241. https://doi.org/10.1016/j.jadr.2021.100241
Javanmard, H., Baharmoghadam, M., & Moradi, Z. (2020). The quality of virtual education during the covid-19 epidemic in public universities (case study: graduate students of Shahid Bahonar University, Kerman). New research approaches in management and accounting, 84(6), 2274-2291. (in Persian)
Karimian, Z., & Farokhi, m. (2018). Eight steps of virtual education development in the transformation and educational innovation plan of universities of medical sciences, a review of an experience. Journal of medicine and cultivation, 27(2), 101-112.
Khosravi.A, Lotfi, F., Yazdankhah.M, & Mirzaee, K. (2021). Evaluation of the views of undergraduate students in the field of medical librarianship and information of medical sciences universities of the country on the status of virtual education of students in 1400. Health Information Management, 18(4), 166-171. (in Persian). https://doi.org/10.22122/him.v18i4.4385
Korani, Z. (2021). The Relationships Self-Efficacy On Academic Burnout Among Students In Razi University. Education Strategies in Medical Sciences, 14(1), 23-34. (in Persian)
Kuo, T.-T. (2020). The anatomy of a distributed predictive modeling framework: online learning, blockchain network, and consensus algorithm. JAMIA open, 3(2), 201-208. https://doi.org/10.1093/jamiaopen/ooaa017
Liu, Y., & Cao, Z. (2022). The impact of social support and stress on academic burnout among medical students in online learning: The mediating role of resilience. Front Public Health, 10, 938132. https://doi.org/10.3389/fpubh.2022.938132
en, Z., Xin, Y., Ge, J., Zhao, Z., Liu, D., Ho, R. C., & Ho, C. S. (2021). Psychological impact of COVID-19 on college students after school reopening: a cross-sectional study based on machine learning. Frontiers in Psychology, 12, 641806. https://doi.org/10.3389/fpsyg.2021.641806
Sadeghitabar, P., & Shariatmadari, M. (2021). Identification of the Dimensions and Components of Continuing Medical Education Based on Blended Learning with Sustainable Development Approach. Environmental Education and Sustainable Development, 9(2), 63-82. (in Persian) https://doi.org/10.30473/ee.2021.7537
Setianingsih, T. Y., Wiyatno, A., Hartono, T. S., Hindawati, E., Dewantari, A. K., Myint, K. S.,... Safari, D. (2019). Detection of multiple viral sequences in the respiratory tract samples of suspected Middle East respiratory syndrome coronavirus patients in Jakarta, Indonesia 2015–2016. International Journal of Infectious Diseases, 86, 102-107. https://doi.org/10.1016/j.ijid.2019.06.022
Shahbeigi, F., & Nazari, S. (2012). Virtual education: Benefits and limitations. The Journal of Medical Education and Development, 6(1), 47-54. (in Persian)
Soltani, P., & Andrade, R. (2021). The influence of virtual reality head-mounted displays on balance outcomes and training paradigms: a systematic review. Frontiers in sports and active living, 2, 531535. https://doi.org/10.3389/fspor.2020.531535
Song, W., Wang, Z., & Zhang, R. (2022). Classroom Digital Teaching and College Students’ Academic Burnout in the Post COVID-19 Era: A Cross-Sectional Study. Int J Environ Res Public Health, 19(20). doi:10.3390/ijerph192013403. https://doi.org/10.3390/ijerph192013403
Yu, A., Wilkes, M., & Iosif, A.-M. (2021). Exploring the Relationships Between Resilience and News Monitoring with COVID Distress. Academic Psychiatry, 45(5), 566-574. https://doi.org/10.1007/s40596-021-01444-9
Zhu, K., Xie, X., Liu, Q., Meng, H., & Song, R. (2022). Internet addiction: Prevalence and relationship with academic burnout among undergraduates during widespread online learning. Perspect Psychiatr Care, 58(4), 2303-2309. doi:https://doi.org/10.1111/ppc.13060
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Received: 2023/05/7 | Accepted: 2024/07/22 | Published: 2025/07/6
Received: 2023/05/7 | Accepted: 2024/07/22 | Published: 2025/07/6
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