Introduction
Improving students’ academic performance is a primary goal of educational institutions. In this context, researchers have indicated emotions as a key factor in creating motivation and academic success [1]. In recent decades, academic motivation has been considered as an important factor in medical education. It can help students achieve educational goals including proper professional performance [2]. The term “achievement emotion” was first introduced by 
n in 2006 in the academic field [3]. Academic achievement emotion refers to the emotions that are directly related to academic activities or academic progress [4]. These emotions can be positive (e.g. pride, joy, hope) or negative (e.g. boredom, anger, anxiety), or active (e.g. pleasure, pride, anger) or passive (e.g. shame), experienced in various educational contexts (before, during, and after class, study, or test) [5]. Positive and negative academic achievement emotions can significantly affect education, learning, and performance of students [6]. Positive emotions expand thoughts, foster curiosity, increase communication with others, help better solve issues, and increase the adaptability [7].
In recent years, there has been an increase in analyzing educational situations with an emotional approach in academic settings [5]. According to Pekrun’s (2010) model, the effect of emotions in increasing academic skills and empowerment is created by a number of motivational mechanisms including motivation for learning [8]. Academic motivation plays an important role in learning and trigger a person’s movement towards behaviors that lead to better learning [9]. Individual and environmental factors have a role in creating academic motivation, and their consideration is especially important [10]. Academic motivation encourages learners to comprehensively evaluate their performance according to the highest standards, to strive for success in performance, to continue learning, and enjoy the pleasure that is associated with success in performance [11, 12]. Academic motivation is related to the level of learning; individuals with high academic motivation have more effort and, thus, achieve more success [13]. 
According to Faridah et al. higher motivation in learners leads to better academic performance [14]. Academic performance is considered as the basis of success and progress in any educational level [15]. It also reflects the success of educational system in achieving its goals. Academic performance of students is one of the important indicators for assessing the efficiency of educational systems [16]. Therefore, any failure in training of student, especially in medical and paramedical fields such as operating room students (who need clinical training in addition to theoretical education) can have severe consequences for society and public health [17, 18].
In December 2019, the outbreak of a viral disease was reported in Wuhan, China, which was later named COVID-19 [19]. Due to its rapid spread and transmission, the World Health Organization (WHO) declared a global health emergency on February 4. To minimize contact in crowded places, complete lockdown and preventive measures were implemented at local, regional, and national levels [19]. As a result, many students worldwide were prevented from attending schools. Considering the high population of students, the density of classrooms, the use of public and common facilities and spaces in schools, the high probability of virus transmission from this group to the society, the care and control of educational spaces was one of the first measures of the countries [20-22]. Virtual education was thus used to continue education during the COVID-19 pandemic, which caused an unprecedented global disruption in education, particularly for medical education, due to the need for both clinical and theoretical training [22, 23]. The unexpected move to online learning increased stress and anxiety, decreased motivation, and caused dissatisfaction with performance in student [24]. All studies that examined psychological disorders during quarantine reported signs of motivational and emotional disorders such as decreased mood, anger, sadness, loneliness, and reduced attention [23], which can lead to adverse effects on students’ academic performance and quality [22, 24]. Cardinas-Flamiano found that the level of academic excitement among students changed during the COVID-19 pandemic and increased after returning to face-to-face learning [25]. 
In the risky situations such as the COVID-19 pandemic, it is necessary to investigate and identify effective psychological solutions and techniques that can maintain students’ achievement emotions and motivations, especially for medical students who also need clinical training, and any failure can have dangerous health consequences. Since most of studies on academic achievement emotions have been conducted in Western countries, and there is no study on Iranian students during the COVID-19 outbreak, this study aims to explore the relationship of academic achievement emotions with academic performance and academic motivation in Iranian operating room students during the pandemic.

Materials and Methods
This is a descriptive-correlational study with a cross-sectional design. Participants were 93 undergraduate students in operating room technology from Iran University of Medical Sciences (31 in the third semester, 32 in the fifth semester, and 30 in the seventh semester). They were selected by a census method. Inclusion criteria were being an undergraduate student in operating room technology at Iran University of Medical Sciences and willingness to participate in the study. Exclusion criteria were unwillingness to continue participation, return of incomplete questionnaires, and semester leave.
The data collection tools were: 

The academic motivation scale (AMS)
This tool was designed by Vallerand in 1992, and has 28 items and three dimensions: Intrinsic motivation, extrinsic motivation, and amotivation in education [26]. Data were rated on a five-point Likert scale from 1 (completely disagree) to 5 (completely agree). The face validity was confirmed by the professors from the Faculty of Educational Sciences. The test-retest reliability with a two-week interval was obtained 0.73, and Cronbach’s alpha value was obtained 0.88 [27].

Achievement emotions questionnaire (AEQ) 
This tool was designed by Pekrun in 2002 [3], and has 51 items measuring eight emotions: Class-related enjoyment, hope, pride, anger, anxiety, shame, hopelessness, and boredom. The items are rated on a 5-point Likert scale from 1 (completely disagree) to 5 (completely agree). In this scale, 36 items are related to negative emotions and 15 are related to positive ones. The total score ranges from 51 to 255, with higher scores indicating higher usage of that emotion. Nikdel et al. [28] validated this questionnaire for Iranian students, reporting Cronbach’s α values of 0.75, 0.76, 0.78, 0.74, and 0.84 for class-related enjoyment, hope, anxiety, anger, and boredom, respectively. For the operating room students, its content validity was confirmed by 10 professors (from Tehran University of Medical Sciences, Iran University of Medical Sciences, Kashan University of Medical Sciences, Alborz University of Medical Sciences, Tabriz University of Medical Sciences, and AJA University of Medical Sciences) who reviewed and provided feedback on the questionnaire. The Cronbach’s α values for the overall scale was obtained 0.863. For its subscales, Cronbach’s α scores were as follows: Anger= 0.712, pride= 0.909, hope= 0.874, class-related enjoyment= 0.744, hopelessness= 0.755, shame= 0.898, anxiety= 0.772, and boredom= 0.906.

Academic performance scale 
The grade point average (GTA) of the second semester in the academic year 2021 was used as a measure of academic performance.
The collected data were analyzed in SPSS software, version 22. Descriptive statistics such as frequency, percentage, mean, standard deviation, were used to describe the contextual variables. The relationships between variables were examined using non-parametric tests, including Spearman’s correlation test. The significance level was set at 5%.

Results
The mean age of the participants was 21.27±1.85 years, where 56% were female and 44% male. Among participants, 33.3% were in the third semester, 34.4% in the fifth semester, and 32.3% in the seventh semester. Housing conditions showed that 31.2% of the students were living in dormitories and 5.4% at a house without parents, and the majority (n=59, 63.4%) resided at home living with their parents.
The mean total score for AEQ was 157.62±21.39. The highest mean was related to the domain of pride (Mean=28.60), and the lowest was related to hopelessness (Mean=9.55). The mean score for academic performance was reported as 16.74±2.43, and the mean AMS score was 89.38±19.65, with the highest score related to external motivation (Mean=42.42) (Table 1).


The normality of data distribution for the variables was examined to determine the use of parametric or non-parametric tests for the research hypotheses. As shown in Table 2, since P<0.05 and was significant, the distribution was not normal. Thus, non-parametric tests were used.


We examined the relationship of positive academic emotions (class-related enjoyment, hope, pride) and negative academic emotions (anger, anxiety, hopelessness, shame, boredom) with the subscales of AMS (intrinsic motivation, extrinsic motivation, and amotivation). The findings indicated that positive academic emotions had a direct and significant relationship with positive academic emotions and both intrinsic and extrinsic motivations, and a negative significant relationship with amotivation. On the other hand, negative academic emotions showed an inverse and significant relationship with intrinsic and extrinsic motivations, and a direct significant relationship with amotivation (Table 3).


The relationship between academic emotions and academic performance was also examined, whose results showed no significant association of positive or negative academic emotions with students’ academic performance (Table 3).
Also, we examined the relationship of demographic variables with academic emotions, academic performance, and academic motivation. The results showed no significant association of age with academic emotions, academic motivation, or academic performance (Table 4).


However, gender and academic semester had a significant relationship with academic performance, where higher academic performance was observed in females and in those from higher semesters (Table 5).


Furthermore, the results showed that the gender factor was significantly correlated with academic motivation, where women showed higher motivation (Table 5). No significant relationships were found between academic emotions and demographic variables (Table 5).

Discussion 
Based on the findings of this study, there was a positive and significant relationship between positive emotions and both intrinsic and extrinsic motivations of students, and a negative and significant relationship between negative emotions and academic motivation. These findings are consistent with the results of Villavicencio and Bernardo, who suggested that positive emotions are linked to some motivation-related variables [29]. Our findings are also consistent with the results of Gholamrezainejad (2019)’s study, which reported the significant relationships of intrinsic and extrinsic motivations with both positive and negative academic emotions [30]. Ahmadi et al. (2021) concluded that training courses based on social-emotional skills can increase academic vitality and motivation [31] which is consistent with our findings. The reason for the relationship between academic achievement emotions and academic motivation in operating room students can be due to the fact that positive achievement emotions may act as forces to enhance motivation during the COVID-19 pandemic. Providing solutions to increase positive emotions and reduce negative emotions in college students can increase their motivation and, consequently, improve their academic performance.
Furthermore, our findings indicated no significant relationship between negative academic emotions and academic performance in students, which is consistent with Hayat [5] results, who reported no significant correlation between negative emotions (such as anger, anxiety, hopelessness, shame, and boredom) and academic performance of students at Shiraz University of Medical Sciences [5]. Some studies such as conducted by Daniels and Stupnisky [32] suggested that boredom negatively affects academic performance, while Cocoradă (2016) found no significant relationship of anxiety and shame with academic performance [33]. 
Our findings showed no significant relationship between positive academic emotions and academic performance in students. This finding is against the results of Pekrun (2006), who reported that positive emotions such as class-related enjoyment, hope, and pride facilitate learning, increase motivation, and improve performance [34]. Cocoradă (2016) concluded that the academic positive emotions such as class-related enjoyment, hope, and pride are positively and significantly correlated with academic performance [33] which is not consistent with our results. The discrepancy may be due to differences in the study duration, study population, or the existing conditions in the university.
Moreover, the results of the current study showed a significant relationship between gender and academic performance of students, where females showed better academic performance. This finding is consistent with the results of Keyvanara [35], Peltzer et al. [36], and Ebadi et al. [37]. Therefore, female students seem to be more able to cope with crises and have higher resilience during the pandemics. In this study, we found a significant relationship between academic semester and academic performance. This may be because first-semester students take more courses compared to those in higher semesters, who receive courses theoretically and virtually (Table 5). 
The results indicated a significant relationship between gender and academic motivation, where female students showed higher motivation compared to males, which is consistent with the results of Rouhi et al. [38], Izadi et al. [39], and Tamnnaifar [40]. Women in Iran are often housekeeper with no financial independence. Maybe the reason for the higher academic motivation among female students is their tendency for higher social participation, employment, and financial independence. Considering the availability of job opportunities in the field of operating room technology, this could be a motive for them to pursuit education. One limitation of this study was the unwillingness of some students to complete the questionnaires, which was mitigated by ensuring them of the confidentiality of their information.

Conclusion
Academic emotions have a significant correlation with academic motivation in operating room students indicating the importance of increasing positive academic emotions of students to enhance their motivation and their academic performance should be strengthened during pandemics using other methods along with virtual education. The educational programs for copying skills, academic motivation, emotion control, self-management skills are also recommended to increase the academic emotions of operating room students. Moreover, providing training on finding effective strategies and counseling to professors, along with talent search programs, can help them to use better methods in designing, planning, and implementing educational courses during pandemics. Future studies are recommended to investigate the effect of teaching methods for increasing positive academic emotions on the academic motivation of operating room students. Furthermore, it is recommended to develope a structural equation model to examine the role of academic stressors in resilience, motivation, and academic burnout in operating room students. 

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval from the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1401.145). 

Funding
This article was extracted from a master’s thesis at Iran University of Medical Sciences.

Authors' contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all students in operating room technology at Iran University of Medical Sciences for their cooperation.


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