Distance Education in Veterinary Medicine: History, Current Situation, and Future Perspectives (a Systematic Review) Educação a Distância em Medicina Veterinária: História, situação atual e perspectivas futuras (uma revisão sistemática)

Technology has revolutionized education making it more accessible, overcoming time and space barriers, and reducing costs for undergraduates and professionals. In veterinary medicine as well as in other knowledge areas, distance education has evolved, going to the forefront of technological advances. Today, many tools, courses, and online platforms are available to facilitate and enhance the teaching-learning process for institutions and students. However, because of the Covid-19 (Sars-CoV-2) pandemic, educational institutions and veterinary medicine students around the world were forced to use distance education tools, many of them without being prepared or knowing the tools available or not having the necessary tools. In this sense, seeking to offer students and educators information about the evolution of distance education in veterinary medicine, its current situation and available tools, it was made a systematic review using the databases Science Direct, Scopus and Google Scholar, gathering more than 244 journal articles, and finally 116 articles were selected. The selected articles were analyzed for the history, platforms, and resources available, difficulties, current situation, and future perspectives, as well as the advantages and need of distance education in the actual pandemic situation. We can conclude that distance education is currently an indispensable tool in veterinary medicine, complementing face-to-face courses and reducing costs. This has led to the development of several platforms, applications and online educational resources that facilitate and enhance the teaching-learning process for educational institutions, veterinary students, and professionals.


Introduction
In education, as among other life fields, technology has brought enormous changes and adaptions to our lifestyles, and because of the modern world, and student and university demands, the usage of tools and online distance learning environments are increasingly common and necessary in higher education (GLEDHILL et al., 2017;PUTRA et al., EaD em Foco,2022, 1(1): e1635 | 2 2021; SAADEH et al., 2021a). The wide popularization and access to computers, made easier the usage of distance education as a learning tool. Along with new information and communications technologies (ICTs), distance education (DE) is now an important and widespread way of teaching and learning, where the student and teacher are geographically distant and their personal interaction is replaced by different media resources making easier the education diffusion, access, and globalization (MAHDY, 2020;DAS et al., 2021;PUTRA et al., 2021).
Veterinary medicine (VM) has passed through several stages in the adoption of DE for the delivery of its' curricula in universities worldwide. Currently the VM students have a large number and variety of electronic resources that complements and helps their learning process (GLEDHILL et al., 2017;STRUBE;RAUE;JANECEK, 2018;SAADEH et al., 2021a). Additionally, the current ICTs can be used by VM faculty to offer courses on subjects in which few faculties have expertise. Students may be reached even out of the institutions and continuing professional development may be provided faster, more efficiently, and less expensively (DHEIN, 2007a;MAHDY, 2020).
Nowadays, DE is the main resource for providing effective and qualified education especially in difficult and social distancing times as in the current pandemic situation because of the Covid-19 (MAHDY, 2020;UNITED NATIONS, 2020;DAS et al., 2021;HUNT;ANDERSON, 2021). Facing this global problem that drastically affects VM students and institutions around the world and for which, not all universities and professors were prepared; it turns necessary for VM educators to understand and learn more about how DE in VM is carried out and how it has evolved over time, as well as the available resources for remote teaching. To provide more information about DE history, platforms available, difficulties, current situation, and future perspectives in VM, it was made a systematic review about these topics to help VM educators and students to cope better with these difficult times and better respond to this necessary and contemporary way of education.

Material and methods
A systematic review about distance education in VM was carried out, aiming to look at the existing literature to understand about its' beginnings, developed platforms, tools and its status worldwide. For the systematic review, the authors conducted research EaD em Foco,2022, 1(1): e1635 | 2 during March 2020 and June 2021 using the keywords (MeSH) "online learning" or "online education" or "distance learning" or "distance education" or "e-learning" AND "veterinary". The research was made using the databases Science Direct, Scopus and Google Scholar, with no year exclusion criteria. Only articles in English, Portuguese and Spanish were included, articles in other languages were not considered. The exclusion criteria included: articles related to postgraduate education and articles not specifically reporting distance education experiences, methodologies, online platforms or other distance education technologies usage or development in VM undergraduate education. Those articles related to areas such as biology, animal science, biomedical sciences, or other but not specifically involving veterinary medicine were also excluded. Only research articles were included, not considering papers like conference proceedings, letters to editor, thesis, reviews, and news. Finally, the PRISMA checklist items were used when applicable (PAGE et al., 2021).
After a preliminary analysis based on the article's title and abstract, 244 journal articles that met the inclusion criteria were gathered, and after the 2 reviewers reading and analyzing the 244 articles, finally 116 articles specifically involving distance education experiences in VM were selected. Based on the selected articles, a compilation of the history of DE in VM was made. Other categories were created to discuss the different findings. The categories were created according to the dominant themes found on the selected articles and in order to create a broad logical line of reasoning discussing then about: the use of platforms and distance education tools, difficulties and challenges of DE, current situation, and future perspectives. Finally, how DE is used in VM during the current pandemic situation of the coronavirus (Covid-19) and social distancing time was analyzed.

Platforms and distance education tools
As internet access is now available worldwide, it is an increasingly common way of learning. Among the tools that may be used via the internet are the Open Educational Resources (OERs  VULCANI et al., 2020;MCMICHAEL et al., 2021). Social media has also been used as a DE tool and delivery method, allowing to share educational material, study cases discussion and interaction between students and faculty.

Difficulties and challenges of DE
As new technologies and online learning advance, DE has shown to have the same quality and, in some cases, being better than traditional learning ( DE may have higher dropout rates than traditional education, commonly related with low quality resources, lack of technology knowledge or poor student support among other factors that may affect students' motivation and learning (VARNHAGEN; WRIGHT, 2008). Additionally, another possible student demotivator associated with EaD em Foco,2022, 1(1): e1635 | 2 asynchronous learning is the lack of face-to-face interaction with colleagues and teachers, the feeling of loneliness and lack of practical application in the clinical setting in the case of VM (PARKES; BARRS, 2021).
In the survey led by Gledhill et al. (2017) with veterinary students around the world, they found that 84% of the students use search tools like Google followed by Wikipedia when looking for information to study, and most were unfamiliar with the MOOCs and OERs. This finding could suggest that most of the students lack the knowledge and skills necessary to properly find accurate and reliable information resources to complement their studies. This is consistent with the research made by Saadeh et al. (2021b) where they found veterinary students prefer use search tools than asking their instructors.

Current situation and future perspectives
In education (online e-learning) has undoubtedly caused the rapid development of distance learning courses and tools by educational institutions. Tools such as MOOCs and OERs are increasingly being developed and used in veterinary education (KUMAR, 2019).
New pedagogical methodologies are increasingly common in higher education. The use of active and student-centered methodologies, such as blended learning (BL), the flipped classroom learning and case-based e-learning are trending and very necessary in VM programs (DOOLEY et al., 2018;KELLY;MIHM-CARMICHAEL;HAMMOND, 2019;DOOLEY, 2020;LONDGREN et al., 2020;SAWRAS et al., 2020;URIBE;JIMENEZ;TRONCOSO, 2020;DUCKWITZ et al., 2021a;PIENAAR;MOSTERT, 2021). Some other methodologies and options newly explored and reported in VM include the Gamification (game-based learning) and Mobile Learning (DE BIE;LIPMAN, 2012;HANNON, 2017;OBER, 2018;FERREIRA et al., 2020;MOLLER KLIT;KIRKETERP NIELSEN;STEGE, 2020;ARAUZ et al., 2021). BL involves face-to-face classroom training mixed with distance learning mainly based on the web. More and more VM programs use this type of methodology in the world, as it combines the advantages of classroom teaching and modern technologies, and in some cases has had more acceptance than traditional classes (EDITH et al., 2017;VOGT et al., 2019;DUCKWITZ et al., 2021b;DUIJVESTIJN et al., 2021;PILLAI, 2021;WASHBURN;COOK;TAYCE, 2021).
On the other hand, Flipped Learning is a form of learning which proposes the inversion of the traditional form of classes based on passive learning. Students must study and familiarize with the content before they arrive in class and previously know the key points of the topic. Content can be made available via the internet, and class time is dedicated for the teacher to guide and monitor the learning process. This methodology EaD em Foco,2022, 1(1): e1635 | 2 has been proved as effective in VM, increasing the student's engagement, autonomy and practical kills development (DOOLEY et al., 2018;DECLOEDT et al., 2020;DOOLEY, 2020;JIMÉNEZ;PEÑA MERINO;CURAY, 2020;LONDGREN et al., 2020;ZHITNITSKIY, 2020;SUKUT et al., 2021).
Case-based learning (CBL) is also a valuable active methodology in VM that permits to familiarize the student with the real-world situations and linking to the learned in class (DUCKWITZ et al., 2021a;MCMICHAEL et al., 2021;NAVAS DE SOLIS et al., 2021). Nowadays exists the possibility to use CBL on DE (Case-based e-learning) and BL, as the theoretical content can be delivered online and practical teaching through face-to-face classes (CREEVY et al., 2018;ALVAREZ;REINHART, 2020;SAWRAS et al., 2020). CBL has also been used in VM through failure cases to enhance the students problem-solving abilities (RONG et al., 2020).
During the current COVID-19 pandemic situation, an international survey with VM students and researchers showed that participants used many electronic devices to keep their studies at distance, been the smartphone the most used, followed by laptop and tablet. While the educational content "were available mostly through online classes and pdf lectures followed by e-books, YouTube videos, university platforms, educational websites, and educational applications". Also, different online tools i.e. WhatsApp, Google Classroom, Google Meets, and Skype, among others, have been commonly used to access online classes (MAHDY, 2020).
The current trend in teaching VM is to make better use of time in face-to-face classes, reduce costs in infrastructure and materials, as well as optimize university resources.
The new tools are more focused on simulation environments, virtual patients, virtual reality, case-based e-learning and online assessment tools, making it less necessary to have physical resources. These actions also improve the animal welfare, the student's clinical confidence and optimize the evaluation processes, especially when there are many students and subjects that have a practical and/or laboratory component. They are also seen by the students as more motivating and effective for learning when comparing with traditional lectures (PEREIRA et al., 2018;ESPITIA et al., 2019;VOGT et al., 2019;BAI, 2020;CALSAMIGLIA et al., 2020;INPANBUTR et al., 2020;SAWRAS et al., 2020).
Future perspectives for DE in VM should be focused on the online learning improvement, the development of new study material, interactive tools, virtual reality, and 3D animations (ESPITIA et al., 2019;MCCAW et al., 2021). E-learning use for DE in VM is expected to increase in the future, mainly among areas like virtual patients and cases that are currently very appreciated by the students (KLEINSORGEN et al., 2018;MCCAW et al., 2021). Virtual Reality is other important area already been developed and that is likely to grow and improve, allowing its usage in several areas and EaD em Foco,2022, 1(1): e1635 | 2 supplementing traditional learning-teaching methodologies. Additionally, augmented reality is increasingly used to improve and ease the learning in areas as anatomy, been this methodology preferred by veterinary students (LITTLE et al., 2021).
In the future, (the post-pandemic era) more than ever, the use of online and virtual educational resources is expected to be used as the main resources for teaching and learning veterinary medicine. As the COVID-19 educational crisis boosted the development of virtual/online educational tools (online platforms, virtual/augmented reality, 3D models, online case-based learning, artificial intelligence, among others); veterinary medicine education is likely to generalize the use of blended learning and in some cases to completely delivery subjects and educational content remotely or mediated by e-learning (JABBAR; GAUCI; ANSTEAD, 2021;LITTLE et al., 2021).

DE during the COVID-19 pandemic
In December 2019, the World Health Organization (WHO) was notified of a new virus outbreak, and on March 11, 2020, the WHO declared the new virus (Coronavirus / Covid-19) as a pandemic (WHO 2020). Faced with this global problem, social distance and isolation strategies have been developed worldwide as alternatives to reduce the risk of contagion. Strategies include the closure of educational institutions in most countries. According to the United Nations (2020) "The COVID-19 pandemic has created the largest disruption of education systems in history, affecting in 2020-2021 more than 1 billion learners in more than 190 countries and all continents".
Although, there are many online resources available, many universities were not prepared for a situation like this and did not have the technological capacity or organized disciplines to be offered via online (PIENAAR; MOSTERT, 2021). Additionally, the poorest countries and students, doesn't have good internet connections or the devices needed to study at home, been these the most affected during the school closures (UNESCO, 2020; UNITED NATIONS, 2020).
In VM the situation is the same as in other areas. years. Parkes and Barrs (2021), also reported the implementation of a learning platform for veterinary students due to the pandemic situation. They reported, the platform and methodology were positively accepted by the students and not represented more difficulties when compared with face-to-face learning. Ward et al. (2021), reported the exceptional transition of the presential clinical rotations of veterinary students to the virtual format because of the COVID 19 pandemic. The authors said the virtual clinical rotations were well accepted by the students and showed equal or higher evaluation scores when comparing to presential rotations. However, they were aware that hands-on skills were difficult to teach virtually, and there could be a lack of knowledge in certain areas. The online survey delivered by Mahdy (2020) with over than 1,400 VM students and researchers from 92 different countries showed that most of the participants (96,7%) consider that COVID-19 pandemic affected their academic life in different degrees. Regarding online learning, involving problems like difficulty to teach practical lessons, sense of loneliness, lack of electronic devices and internet to access the educational content, among many others. Despite of those problems, participants also reported advantages like online learning is more flexible, permits self-study and more time to learn. This is consisted with reported by Freitas Ribeiro (2021) with VM students in Brazil, Parkes and Barrs (2021) in Hong Kong and Das et al. (2021) in India.

Conclusions
DE in VM has become very popular, being currently an indispensable tool to complement face-to-face courses, reduce costs and offer education to those who cannot go in person to educational institutions. This has led to the development of several platforms, applications and online educational resources that facilitate and enhance the teaching-learning process for educational institutions, veterinary students, and professionals. New technologies such as virtual reality and clinical simulators have helped in the process of reducing animals in classes, reducing the time for face-to-face practices, and reducing costs. In the future, more open educational resources, simulators, and virtual environments should be developed to enhance DE in VM, offer EaD em Foco,2022, 1(1): e1635 | 2 an improved learning experience to students and optimize the resources and staff for faculty.
The COVID-19 pandemic situation has forced institutions to offer their courses by distance learning, for which many were not ready. However, this may be the propitious occasion to generate partnerships between institutions and start to develop more virtual learning tools. Doing so may strengthen and make better use of distance learning, as well as help to avoid an educational crisis that interrupts the training process of VM students.
Some limitations of this systematic review include studies published in other languages than English, Spanish, and Portuguese. Besides of those articles not indexed in the selected databases.