U.S. Medical Student Experiences During the COVID-19 Pandemic: A National Survey.

Purpose:

The COVID-19 pandemic has and continues to greatly disrupt medical education in the United States and may negatively impact the well-being of medical students, a population that already experiences high levels of baseline mental distress. [1-3] While research suggests that disaster situations can exacerbate mental distress in health care workers, medical student experiences are not well understood. [4] We conducted a national, cross-sectional survey of U.S. medical students during the COVID-19 pandemic to (1) understand student experiences and concerns and (2) identify priority areas to inform development of student support services.

Methods:

From May to June 2020, we electronically surveyed enrolled students at 22 U.S. Liaison Committee on Medical Education-accredited medical schools regarding their pandemic experiences. Likert responses were dichotomized, and t tests, chi-square tests, 1-way ANOVA, and unadjusted odds ratios were used to compare results across subgroups. Analyses were conducted using R (v.3.6.1; The R Foundation, Vienna, Austria).

Results:

Of 12,389 students, 3,826 responded (31%). The most common pandemic experiences were limited access to physical activity and outdoor spaces (68%), tension between personal safety and professional duty (38%), and financial strain (30%). Black and Hispanic students were 2.3 times as likely to experience financial strain compared to other racial groups (P < .0001).

Students’ top 3 concerns were a loved one getting sick (70%) and COVID-19 impacts on society (44%) and their clinical training (35%). Only 17% reported personal health as a top concern. Most (54%) felt stronger in their resolve to be a physician, and only 14% were now more likely to choose a frontline specialty.

Over half (54%) were satisfied with access to school support, but Black and other racial minority students reported lower satisfaction (P = .004). While most were satisfied with mental (51%) and student health (43%) access, those living in the same state as their school during the pandemic were more satisfied than those living out of state (53% vs 46%, P = .001 and 44% vs 36%, P = .0001, respectively). Additionally, Black and Asian students reported lower satisfaction with mental (P < .0001) and student health (P = .0005) access than other racial groups. Nearly half (47%) were satisfied with academic advising, with no differences by race or in-state status.

Notably, 17% reported a family member being diagnosed with COVID-19, 4% were diagnosed with COVID-19 themselves, and 4% experienced a COVID-19-related death of a loved one. Black and Hispanic students were 1.8 times as likely to report these personal experiences with COVID-19 compared to other racial groups (P < .0001). Students reported an increase in self-care (41%), negative coping mechanisms (41%), and caregiver stress (24%). There were no significant differences across sex, race, or marital status.

Discussion:

This is the first national study to describe U.S. medical student experiences during a global pandemic or national emergency. Students were more concerned about their loved ones’ health and the societal impact of COVID-19 than their own personal health. Additionally, the pandemic reaffirmed most students’ decision to pursue medicine. Interestingly, while students reported an increase in negative coping mechanisms and caregiver stress, they also reported increased self-care, possibly related to additional time gained from removal from clinical responsibilities. Moving forward, these disparate experiences with financial strain, caregiver stress, COVID-19 illness, and school support resources must inform how medical schools develop programming to support all students, with special attention to racial minorities and out-of-state students who may be disproportionately affected.

Significance:

The COVID-19 pandemic continues to bring out unprecedented changes to U.S. medical student education and well-being. This study highlighted racial differences in experiences with financial strain and COVID-19 diagnoses that may reflect socioeconomic inequalities exacerbated by the pandemic. Given the ongoing pandemic, medical schools are tasked with adapting resources to support these unique experiences and vulnerable groups.