In light of the increasing use of online learning platforms in medical education, there is a critical need to assess the current state of online learning environments. Despite the global emphasis on digital education, limited studies have systematically explored how medical students perceive the effectiveness and quality of these environments, particularly in Pakistan. This study aims to fill this gap by evaluating medical students’ experiences with their institution’s online learning environments and identifying key strengths and challenges that impact learning outcomes. A mixed-method, sequential exploratory design was used, starting with a quantitative assessment followed by qualitative inquiry. Data from 253 medical students were collected via a survey, and 30 focus group interviews were conducted to provide deeper insights into the challenges students face in navigating the online learning environment. The findings revealed critical areas in need of improvement, including digital infrastructure, student engagement, and the accessibility of online resources. Qualitative data highlighted the need for more interactive and student-centred approaches to online education. By focusing on the status of online learning in medical education, this research provides valuable insights for educators and policymakers aiming to enhance the quality of digital learning environments. The study contributes to ongoing efforts to develop more effective, engaging, and responsive online learning strategies for medical students in Pakistan.
Education, Distance ; Education, Medical, Undergraduate ; Perception

OBJECTIVE: Transseptal or sublabial transsphenoidal surgery has been standard teatment for pituitary tumors for decades. However, as an alternative to this surgery endonasal endoscopic technique has been reported with encouraging results. We have started endoscopy-assisted transsphednoidal surgery from May 1998. In this paper we analyzed the methods, outcome, advantage and disadvantage of this surgical approach for the purpose of planning optimal treatment of pituitary tumors. METHODS: This study consisits of 13 cases of pituitary tumors who were treated by endoscopy-assisted transsphenoidal surgery using one nostril from May 1998 to July 1999. Mean follow up period was 12.9 months. RESULTS: There was no septal or sublabial incision and little surgical damage to nasal structure. With this technique, rapid surgical approach and short hospital day were possible, being 3-6 days in patients without CSF leakage. Using various angled endoscope, good surgical view was obtained. Initially it was difficult to use various instruments in narrow nasal cavity, but became feasible after several procedures. Among 13 cases, total removal was possible in 11 cases. One of two cases in whom tumor was incompletely removed underwent gamma-knife radiosurgery and second underwent reoperation through subfrontal approach. There were 6 cases of hormone secreting tumors and hormonal remission was achived in all of these cases. Postoperative complications were CSF leakage(6 cases), diabetes insipidus(2 cases) and panhypopituitarysm(1 case). Lumbar drainage was done in all cases of CSF leakage. CONCLUSION: The advantage of endoscopy-assisted transsphenoidal surgery are rapid surgical approach, low postoperative morbidity, short hospital day and good surgical view. The disadvantage of this appoach are difficulty in manupulating various instruments in narrow nostril and difficulty in distance perception but these problems can be overcome by practice and using stereoscopic endoscope.
Distance Perception ; Drainage ; Endoscopes ; Endoscopy* ; Follow-Up Studies ; Humans ; Nasal Cavity ; Pituitary Neoplasms* ; Postoperative Complications ; Radiosurgery ; Reoperation