Student motivation and perceptions during the post-pandemic transition to in-person learning: a mixed-methods cohort study in pathological anatomy education

Abstract Background The COVID-19 pandemic altered medical education, particularly in disciplines that rely heavily on in-person learning, such as Pathological Anatomy. Understanding students’ perceptions and motivational profiles during the transition back to face-to-face education is essential for informing pedagogical reconstruction in the post-pandemic context. Guided by the ARCS (Attention, Relevance, Confidence, Satisfaction) model, this study analyzed medical students’ perceptions and motivation regarding teaching, learning, and assessment processes in a pathological anatomy course during the return to in-person education after the COVID-19 pandemic. Methods A mixed-methods case study, comprising a longitudinal qualitative component and a repeated cross-sectional quantitative component, was conducted with a single group of medical students enrolled in Pathological Anatomy I and II during the 2022 academic year at a Brazilian public university. Student motivation was assessed using the Brazilian validated version of the Instructional Materials Motivation Survey (IMMS-BRV). Qualitative data were collected through classroom observations documented in a field diary and semi-structured interviews. The findings were integrated through triangulation and interpreted according to the four ARCS domains. Results A total of 80 students participated in the quantitative phase, responding to the survey in at least one semester. Overall motivation scores increased slightly from the first semester (mean = 3.29) to the second semester (mean = 3.45), although no statistically significant differences were observed between semesters ( p > 0.05). The Attention and Relevance domains showed higher scores, suggesting that students perceived course organization and professional applicability as motivating factors. In contrast, Confidence showed lower scores, reflecting perceived learning gaps related to the remote learning period. Satisfaction scores were moderate and improved over time; however, they were often accompanied by fatigue and pressure associated with academic demands. Students also highlighted the central role of theoretical examinations. Conclusions The return to in-person medical education after the COVID-19 pandemic represented a complex educational transition. While students recognized the pedagogical organization and clinical relevance of Pathological Anatomy, motivational experiences were shaped by tensions between engagement, academic pressure, and adaptation to the renewed in-person learning environment. These findings suggest that integrating more formative and diversified assessment strategies may enhance student engagement and confidence in similar educational transitions.