Retention of Cardiorespiratory Anatomy Knowledge Among Universitas Ailangga Medical Students With History of COVID-19

Cardiorespiratory anatomy is fundamental knowledge for doctors. However, knowledge retention in medical students decreases over time. Retention is a reflection of memory ability and is affected by many factors, such as COVID-19 infection. COVID-19 is a disease caused by Sars-CoV-2 and has been declared as a pandemic since March 11^th 2020. During the pandemic, cardiorespiratory anatomy tests were held in the 1^st semester and 4^th semester. The objective of this research was to measure the retention difference between students who had suffered from COVID-19 in that period and the ones without a history of COVID-19. This research was a cross-sectional descriptive analytics observational study involving 59 medical students at Universitas Airlangga, Indonesia. It was known that 19 students had suffered from COVID-19, while the other 40 had not. The average score of overall students experienced a significant decrease from 1^st semester to 4^th semester (p=0.000), both for students who had (p=0.023) and had not suffered from COVID-19 (p=0.001). However, the 1^st semester and 4^th semester cardiorespiratory anatomy scores of students with a history of COVID-19 were lower than students without a history of COVID-19. Besides scores, the cardiorespiratory anatomy knowledge retention of students who had suffered from COVID-19 (M=86.72%) was also lower than students who had not (M=86.95%). Nevertheless, the retention difference between those two groups of students was not significant (p=0.703).

INTRODUCTION

Anatomy is a mandatory course for a doctor because it is the basis of medical science, which includes the structure and function of the human body¹¹. Understanding cardiorespiratory anatomy is very important for healthcare professionals considering the high prevalence of cardiovascular and respiratory diseases in Indonesia, ranging from heart disease at 1.5%, asthma at 2.4%, hypertension at 8.4%, to stroke at 10. 9%^2,323.

Knowledge retention describes an individual's ability to store knowledge in long-term memory, which will eventually be recalled. Long-term memory is consolidated from short-term memory and working memory. Memory abilities are included in cognitive functions along with perception, attention, decision-making, and language comprehension^4,545.

The brain is the main organ for memory processing, especially the hippocampus and thalamus area. Lesions to the brain, whether due to trauma or disease, affect memory abilities⁶⁶. Patients who have suffered from Coronavirus Disease 2019 (COVID-19) experience decreased cognitive function which is based on working memory dysfunction⁷⁷. COVID-19 is caused by infection with the Sars-CoV-2 virus⁸⁸. This virus mainly attacks lung epithelial cells, then causes inflammation and collapse of the lungs⁹⁹. This will disrupt the oxygen diffusion, ventilation, and perfusion processes. Lack of oxygen in circulation will cause the brain to endure hypoxic encephalopathy and lead to tissue death¹⁰¹⁰.

COVID-19 was newly discovered at the end of 2019 and declared by WHO as a pandemic on March 11^th2020. As of March 2^nd2022, there had been 437 million confirmed cases and 5.9 million deaths due to this disease¹¹¹¹. This pandemic became the basis for the Ministry of Education, Culture, Research, and Technology, Republic of Indonesia to instruct the change in learning mode to online and then hybrid¹²¹². The 1^stsemester and 4^thsemester cardiorespiratory anatomy tests in the Faculty of Medicine Universitas Airlangga, Indonesia were held during the COVID-19 pandemic. The cardiorespiratory test in 1^stsemester was held online in January 2021, while in 4^thsemester the test was held offline in March 2022. Based on that, this research was carried out to determine the frequency of students who had suffered from COVID-19 during this period and the differences in cardiorespiratory anatomy knowledge retention between this group of students and students who had never suffered from COVID-19.

MATERIALS AND METHODS

The ethical clearance number 168/EC/KEPK/FKUA/2023 for this study was obtained from the Faculty of Medicine of Universitas Airlangga's Ethical Committee on June 26^th2023. This research was a descriptive-analytical observational study with a cross-sectional design. The population for this research was medical students of Universitas Airlangga, Surabaya, Indonesia, class of 2020. Questionnaires were used to collect respondents’ consent, identity, and history of suffering from COVID-19 before the cardiorespiratory anatomy test in 4^thsemester. Data were retrieved from the Department of Anatomy, Histology, and Pharmacology to collect 1^stsemester and 4^thsemester cardiorespiratory anatomy scores of students who were willing to become research subjects. All students who were willing to be research subjects and had filled out the questionnaire completely were included in this study. However, students who had been assistant lecturers in anatomy courses, won anatomy competitions, and repeated courses were excluded. Data were processed into frequencies, distributions, and percentages using Microsoft Office Excel 2019, while statistical mean comparison and odds ratio tests between variables were tested using SPSS.

RESULTS

The research subjects were 59 students from a total population of 281 students. The students’ age range was 20-23 years old. The number of female students (69.5%) was greater than male students (30.5%). Based on the history of COVID-19, it was discovered that 19 of them (32.2%) had suffered from COVID-19 while the other 40 (67.8%) had no history of suffering from COVID-19.

Table 1.General Characteristic..

Variables	Total (%)
Populations	281
Sample Size	59 (100%)
Age Distribution	20-23 years old
Sex
Female	41 (69.5%)
Male	18 (30.5%)
History of COVID-19
Had been suffered from COVID-19	19 (32.2%)
Had not suffered from COVID-19	40 (67.8%)

The cardiorespiratory anatomy scores summary for 1^stsemester showed that the overall average score was 44.07. Students with a history of COVID-19 had lower 1^stsemester average scores (43.16) than overall students or those who had not suffered from COVID-19 (44.5). In 4^thsemester, the average score decreased from 1^stsemester score. This score decrease happened to overall students, both with or without a history of COVID-19. In the 4^thsemester, the average scores for overall students, students with COVID-19 history, and students without COVID-19 history were 30.95, 29.88, and 31.45 respectively. After being processed using paired t-test, it was known that the difference between 1^stand 4^thsemester scores was a significant decrease in all three groups: overall students (p=0.000), students who had suffered from COVID-19 (p=0.023), and students without a history of COVID-19 (p=0.001). The percentage of students who had a score decrease was greater in the group of students with COVID-19 history (73.68%) compared to students without it (67.5%). Based on the odds ratio, students who had suffered COVID-19 were 1.34 times more at risk of score decrease compared to students without a history of COVID-19 (p=0.630).

Because there was a decreased score from 1^stto 4^thsemester, the percentage comparison between