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Academic-associated emotions before and during the COVID-19-related online semester – a longitudinal investigation of first-year medical students

Background: Due to the COVID-19 pandemic, students have been confronted with an online semester. Because of the special requirements, online teaching can trigger negative emotions, which can have an unfavourable impact on the learning process and which therefore need to be regulated. This study investigates academic-associated emotions and the regulation of those emotions both before (December 2019) and during (June 2020) the online semester for first-year medical students. Methods: Questionnaire data (t1=Dec 2019; t2=Jun 2020) regarding academic-associated emotions and emotion regulation, taken from a longitudinal research project (Experienced Learning Medicine Augsburg; ELMA) at the University of Augsburg, was used. At t2, the students were also asked, as future physicians, to name their three most significant emotions regarding their studies, taking into account the COVID-19 situation. Results: Longitudinal analyses (Wilcoxon tests) showed few changes in academic-associated emotions. The emotions happy (r=.32) and proud (r=.33) increased significantly with moderate effects at the online semester. There also was an increased, but still low suppression of emotions (r=.22) at t2. The future physicians were most often curious, grateful and afraid about their medical studies with regard to the COVID-19 situation. Overall, medical studies were more often associated with positive than negative emotions during the online semester. Conclusions: The results show that the online semester did not have any worrying impacts on academic-associated emotions and emotion regulation. There was even some indication that students might benefit from online teaching formats.


Background
The COVID-19-related online semester has placed unusual demands on students (e.g. less social integration and higher self-regulation of the learning process than in faceto-face teaching), which could trigger negative emotions (e.g. frustration) [1], [2]. This can be problematic, because a successful learning process, including high academic performance [3] and favourable motivational situation [4], [5], is ideally accompanied by positive emotions. Emotion regulation strategies enable individuals to consciously influence the intensity, duration and quality of the experience and expression of emotions [6], [7]. The strategy suppression involves repressing emotional expression, while cognitive reappraisal is the active cognitive reinterpretation of emotional situations [8]. In the latter, the meaning of an emotionally triggering situation is reinterpreted [6], which should lead to a more positive emo-tional reaction [8]. For example, frustration caused by the complexity of learning materials might be avoided or mitigated by viewing the situation not as a threat, but as an opportunity to acquire knowledge. Higher performing students have been found to more often apply cognitive reappraisal [9], which simultaneously reduces negative emotions [10]. This study examines academic-associated emotions and their regulation in first-year medical students before and during the COVID-19-related online semester.

Design
The study used longitudinal data, which had been voluntarily provided via questionnaire, that was collected by
The emotion regulation strategies suppression (4 items, α=.74) and cognitive reappraisal (6 items, α=.76) were recorded by the mean values of the Emotion Regulation Questionnaire (ERQ; 7-point Likert scale ranging from 0not at all to 6-absolutely) [8], [12]. In their role as future physicians, the students were also asked in the June survey to complete the following statement: "The COVID-19 situation makes me feel… about my medical studies. Please select the three most appropriate emotions."

Analyses
The data was analysed descriptively and using Wilcoxon tests (ordinal scale level and restricted normal distribution).

Results
The longitudinal analyses of academic-associated emotions are shown in table 2.  Curiosity, gratitude and being afraid were the emotions most frequently described by the future physicians in regard to the COVID-19 situation. Overall, despite the COVID-19 situation, medical studies were more often associated with positive than negative emotions (see figure 1).

Discussion
While most academic-associated emotions did not change longitudinally, happy and proud did increase significantly during the COVID-19-related online semester. This might be because of the free allocation of time, individual adaptation to the pace of learning and the time saved by not commuting [13], [14]. This latter reason was mentioned as a form of relief in an additional scale in the questionnaire that assessed burdens and reliefs. Semester-related teaching evaluation results across all courses also showed a high level of satisfaction with online teaching. The increase in pride could be related to the completion of a systemically relevant training, al-though there is no explanatory data available to support this hypothesis. Disappointment also increased significantly during the online semester, but with only a small effect size. This could be due to the elimination of practical teaching units and reduced peer contact, both were reported as burdens.
Presumably, the COVID-19 online semester led to a severely different student life, which might also be a reason for increased disappointment. The emotion regulation strategy suppression saw a significant increase, but with a small effect size, which might be related to the home learning environment during the online semester, which was perceived as a burden. When asked which three emotions towards medical studies were most triggered by the COVID-19 situation, curiosity, gratitude and being afraid were most frequently mentioned. Curiosity might refer to the many unknown variables associated with the pandemic [15] and the possibility of acquiring new knowledge [16], while gratitude might relate to the benefits of the online semester described above [13], [14]. However, examinations without prior class attendance were seen by a majority of students as a burden and thus possibly an indicator of being afraid, but the data does not allow for a causal explanation and so these hypotheses should be treated as a cautious interpretation. The results suggest that the exclusive online teachingat least, after a short period of time -had no worrying impact on the students' emotions. However, it should be noted that the data is from a model study programme currently being developed with a small student cohort.

Future research
With regard to the ongoing significant reduction in faceto-face teaching, the student cohort will continue to be monitored longitudinally, with a view to a (gradual) reintegration process [17]. There will also be additional investigation of study-life balance to better clarify emotional developments.