Medical Students and COVID-19: Challenges and Supportive Strategies.

As coronavirus disease 2019 (COVID-19) pandemic continues to spread across the world, it is also adversely affecting medical student education. In addition, COVID-19 poses several challenges to medical students' physical and mental health and their professional identity formation. Medical students are experiencing increasing anxiety due to the COVID-19 disruption. Medical students show higher rates of depression, suicidal ideation, and stigmatization around depression and are less likely to seek support. It is therefore important to safeguard their mental health and implement effective strategies to support their educational, physical, mental, and professional well-being.

Introduction

These are unprecedented times. Coronavirus disease 2019 (COVID-19) pandemic has disrupted medical student education (MSE) drastically. Medical students (MS) are now limited to virtual education due to their displacement from both clinical rotations and their medical school campuses. This interruption poses a huge challenge to MS and MSE.

MS Challenges During COVID-19

Medical students are retracted from clinical experiences. Entire curriculum is transitioned to virtually delivered format. There is no on-campus activity. Exams are being offered online. Licensure exams are delayed. Students who must continue patient contact through this pandemic are limited with their respiratory assessments due to lack of adequate personal protective equipment (PPE) thereby compromising their comprehensiveness in clinical experiences. Furthermore, certain specialties require MS to attain letters of recommendations from nonhome institutions for their residency applications needing visiting electives. These electives are currently not feasible due to existing travel bans thus impacting MS applying for 2021 residency training.

Medical students are experiencing increasing anxiety as COVID-19 gradually affects their physical, emotional, and mental well-being. Long-standing social distancing can have negative effects on mental health. Current pandemic can worsen already existing mental health conditions. With the death numbers increasing by the day and with news and social media flooded with COVID-19 discussions, it is hard to stay unaffected. Adapting to the new “normal” of MSE with lack of on-campus learning, absence of peer interactions, omission of direct patient care involvement and increasing barriers in professional identity formation as MS struggle with finding their worth in health care is beyond challenging. Medical students are a vulnerable population globally and according to one study are known to show higher rates of depression, suicidal ideation, and stigmatization around depression and are also less likely to seek support.[1] Another global study assessing the mental health of MS from 12 different countries demonstrated alarming high rates of mental health problems, burnout, substance abuse, and mental stress in MS.[2] It is therefore important to safeguard MS mental health with an effective plan to support their wellness and education.

Supporting MS Physical Health

Medical students are our future and it is imperative to protect them. Medical schools are taking every effort to prevent MS’ exposure to COVID-19. Suspension of MS’ patient-contact participation has been implemented nationwide primarily for their own safety and to take in account existing shortages of PPE.[3] For MS who must participate in clinical experience, appropriate use of PPE is warranted. Medical students with history of exposure should be appropriately quarantined. Medical schools should maintain a list of all MS with a history of exposure and continue to follow them up for evolving symptoms and direct them to their physician for further help. Those with the disease should receive prompt medical care. Medical students with underlying medical conditions should be recommended to discuss their care with their primary doctor. Inquiring about student needs for food, water, shelter, finances, hygiene, daycare needs for their children, etc, is equally important.

Supporting MS Mental and Emotional Health

Assessment of mental health of MS (n = 7143) from Changzhi Medical School, China, demonstrated self-reported anxiety in 25% participants.[4] Another study on health professional students (n = 1442) including MS at Sichuan University, China, showed presence of COVID-19-related psychological distress in 27% participants with 11% exhibiting an acute stress reaction to COVID-19. Learning from China’s experiences about COVID-19-related mental health challenges in MS, medical schools globally should bolster mental health support for their MS. Medical schools should continue to stay connected with students virtually. Casual “checking in” emails to keep an open communication is a great way to allow students to reach out if needed. Weekly class meetings on an online platform will allow students to engage with each other and share thoughts and struggles. It will allow them to “connect” despite social distancing. Limiting multiple separate communications about COVID response and having one single robust weekly communication sharing the action plan is a good way to decrease student anxiety and bring some organizational order amid chaos. Offering mental health visits, preferably free of charge, and with the ability of maintaining anonymity will encourage MS to seek help and receive professional assistance to battle through their negative emotions. It is noted that physical and substance abuse can increase during social distancing as time spent at home increases and hence asking about it and providing support becomes essential. Planning for a virtual celebration for their graduation would probably brighten their day.

Supporting MS Education

Medical educators are already diligently supporting MSE. In addition, 2020 graduation requirements should be amended institutionally to help timely student graduation. Schools could consider early graduation for their final year students to graduate their students early to bolster the physician task force for the pandemic; some schools have already taken this brave decision. Residency programs should consider loosening their intake criteria for 2021 taking in account inability of students to do visiting electives. Alternatively, programs typically offering visiting electives should continue to offer them as tele-electives if feasible. With adequate availability of PPEs, MS should be allowed back in clinical rotations to learn valuable lessons in handling pandemic situations from frontline medical warriors. There are certain lessons in the curriculum that cannot be learned from textbooks. Schools should consider adding high-value, virtually deliverable, credit electives such as scientific writing, narrative writing, COVID-19 facts, biostatistics to continue student engagement in replacement of clinical experiences. Individualized career guidance to every student will be beneficial.

Supporting Sense of Value, Self-Worth, and Adequacy in MS

Medical students are an asset to health care. While currently unable to contribute in hands-on patient care, they can certainly help in other nonclinical aspects of medicine such as COVID-19 phone-triaging, telehealth, phone-based patient care services, providing childcare for health care workers. It is important for us as physicians to nurture altruism and feeling of usefulness in our future physicians as we fight this pandemic.

Both the University of Wisconsin School of Medicine and Public Health and the Medical College of Wisconsin collaborated to describe how they are individually responding to the current need of a revised medical education curriculum delivery in light of COVID-19 with their complete transition to virtual learning.[5] However, there are no reported measures in literature addressing MS mental health during COVID-19. Supporting our future physicians is critical as we face physician shortages, especially during COVID-19. We can unitedly combat this unprecedented COVID-19 disruption and emerge as a strong, compassionate, and adaptive community. Health care worker’s altruism and dutifulness will ultimately win against COVID-19.