The COVID-19 pandemic, which has startled all of us, caused rapid and major changes in the higher education system of Iran, especially in the field of medical education. Although since 2001 the education system is trying to use virtual /distance education (1), until the start of the pandemic, e-learning had a low share in the educational programs of most medical universities and was considered as a less important secondary educational method. Since controlling the pandemic requires avoiding face-to-face training, e-learning is the most important way to provide educational content and holding courses in almost all medical universities of Iran.
According to the literature, e-learning is faced with five challenges related to the university, professors, students, e-learning systems, and e-classroom environment (2). However, there are studies which mentioned to four categories of challenges, including technical and technological (weakness in telecommunications infrastructure), teachers and learners (unfamiliarity with the structure and technology used for e-learning), ethical challenges (weakness of existing technologies for fraud detection), and problems related to psychological issues (technology-related anxieties such as power and internet outages and system crashes) (3). Since the onset of the pandemic in Iran was simultaneous with the start of the new educational semester, there was no opportunity for proper planning. Therefore, most of the medical universities focused their planning, policies, and activities on finding proper educational platforms (while having eyes on costs, convenience, etc.) to provide educational content (either online or offline), creating or modifying the infrastructure of distance/electronic/online education, and providing intensive training courses for familiarizing university teachers with these methods of education and Learning Management Systems (LMS). It seems that less attention is paid to students, who are the other side of e-learning systems. We, unfortunately, ignored that a sudden shift from an almost complete face-to-face education to complete e-learning creates challenges for students. It was assumed that, if correct educational content (according to educational objectives) be provided correctly by the professors and through a proper communication path, students would receive the content correctly.
Although nowadays students are Millennials or from the Z generation and we name them as digital citizens or the Internet generation, however, their ability to use e-learning systems is different. For face-to-face instruction, it was emphasized that students' differences should be taken into account to increase the effectiveness of the education, but
this has been overlooked in our current e-learning systems, which may be due to the rapid and forced transformation from face-to-face to the electronic methods.
Given that likely, the coronavirus will be with us for at least the next two years, so students' challenges in e-learning and related factors should be addressed. If the current situation is properly understood, it would be possible to take timely and effective steps to provide evidence-based interventions for effective electronic training and evaluations.