Psychological effect
Mental health crisis is inevitable during and after the pandemic. The mental health effects of COVID-19 will further affect physical health after the outbreak. (Siu et al., 2021), this was the case in the findings as anxiety was reported by all the participants with most of them experiencing moderate anxiety which is in direct correlation with having mental health crisis
The results indicated a huge effect of COVID 19 pandemic on the training of clinical students which is in agreement with a study by (Ainamani et al., 2020), which stated that the mayhem created by the COVID-19 pandemic and the public health measures to contain it have negatively effected society and mental health of the people world-wide.
In a repeated questionnaire-based cross-sectional study conducted among medical students ranging from 1st year to 5th year at Astana Medical University in the 2019–2020 academic years. The findings revealed that prevalence of the burnout syndrome, depression, anxiety, and somatic symptoms decreased after transitioning from TL to OL. However, during the OL period, the prevalence of colleague-related burnout increased, which tells us about the negative effect of OL on students’ communication and interpersonal relationships (Lovibon & Loviband, 2003). The results of the study conferred with this as anxiety was noted in majority of the respondents. This further correlates with a study in Malaysia during the peak of the corona crisis and the pertinent characteristics affecting anxiety, using Zung’s self-rating anxiety questionnaire. Out of the 983 respondents, 20.4%, 6.6%, and 2.8% experienced minimal to moderate, marked to severe, and most extreme levels of anxiety. Female gender (OR = 21.456, 95% CI = 1.061, 1.998, p = 0.020), age below 18 years (OR = 4.147, 95% CI = 1.331, 12.918, p = 0.014), age 19 to 25 (OR = 3.398, 95% CI = 1.431, 8.066, p = 0.006), pre-university level of education (OR = 2.882, 95% CI = 1.212, 6.854, p = 0.017), management studies (OR = 2.278, 95% CI = 1.526, 3.399, p < 0.001), and staying alone (OR = 2.208, 95% CI = 1.127, 4.325, p = 0.021) were significantly associated with higher levels of anxiety. The main stressors include financial constraints, remote online teaching and uncertainty about the future with regard to academics and career. Stressors are predominantly financial constraints, remote online learning, and uncertainty related to their academic performance, and future career prospects (Sundarasen et al., 2020), (Sundarasen et al., 2020). In the same regard the results of the study showed employment status to be one of the main factors affecting the training of clinical students during the pandemic other factors included gender, course offered, society and academics.
In a study in the United States in which COVID-19’s effects on clinical students were assessed, of the 852 students who participated, 66 .1% experienced, mild, moderate, or severe anxiety. Stress ranked highest in second- through fourth-year students. Students with preexisting mental health conditions had significantly higher stress and anxiety scores, and higher percentage of stress attributed to COVID-19 (Guo et al., 2021). From the results of the study anxiety was highest in third year students which are mostly final year student doing diploma courses this meant that final year students had the greatest effect on their training.
In UK ,there was a 12% incidence of major depression among medical students especially during their first two years of study(Yousif et al., 2017).Generally, in the current situation, Medical students have been highly worried about being infected with COVID-19 during their clinical rotations (Torun & Torun, 2020). Majority of medical students wanted to return to training during the COVID-19 lockdown and were willing to accept the risk of infection.(Harries et al., 2021). From the responses this was the case as most of the respondents were willing to risk infection with COVID19 but resume face to face interactions.
Socio- economic effects
The pandemic with its countermeasures has had grossly negative effects on the economy of many countries worldwide(Aneja & Ahuja, 2021; Bartik et al., 2020). This was the course as participants noted financial constraints to aid them in online studies as well as resuming face to face sessions.
Due to the government efforts to decongest schools and other public places, social interactions have greatly dropped(Torun & Torun, 2020).This coupled with economic regression in families and the country at large has led to difficulty accessing essentials like personal items, and maintaining the cost of online learning has further become difficult.(UNDP, 2020). This was observed as more than 10% of the participants could not assess any of the online learning platforms.
In Nepal a review of published articles related to psychosocial effects due to COVID-19 and other outbreaks were searched and reviewed it was concluded that while many countries are supporting their citizens with sophisticated health safety-nets and various relief funds, some developing countries have unique challenges with vulnerable populations and limited resources to respond to the pandemic (Poudel, 2020), it was observed that some participants could not access a smart phone or laptop to aid in online learning.
In most studies, social isolation from peers has been found to have a significantly higher risk towards suicidal tendencies(Fanelli et al., 2020). Social isolation was observed by the fact that most respondents were not comfortable staying in their communities.
Academic effect
Training of clinical students including clinical rotations came to a standstill due to the COVID-19 pandemic for fear of risk of infection to the students (Harries et al., 2021) this was the case for clinical students attached to MRRH as they had to go home due to the lockdown as result of the pandemic.
Most Ghanaian students faced challenges on e-learning platforms rolled out which included limited access to internet and lack of the technical knowhow of these technological devices hence in this study recommendations were made for students to be introduced to innovative and offline e-learning platforms to supplement classroom teaching and learning and also be of benefit to students who may not have access to internet connectivity (Owusu et al., 2020). Results indicated respondents having a limited access to e learning materials with only no single learning platform having 100% usage which is in direct correlation with the study on Ghanaian students.
Respondents noted effect of the pandemic on their academic progress which part of the noted concerns was extended graduation time, reduced contact with patients, and reduced study time, this was the same case with research focusing on redressing the effect of COVID-19 on medical education in Africa, diseases towards COVID-19, it was established that COVID-19 has disrupted both in- class lectures and clinical training of medical, nursing and other allied health students in Africa. The lack of adequate personal protective equipment (PPEs) created unsafe environments for health workers thus the challenges created by COVID-19 are not insurmountable. Early implementation of common- sense solutions would enable African countries to capitalize on this opportunity to build better medical education systems (Ossai & Ogbuoji, 2021).
However, there is no clear statement/ information describing the effect of COVID 19 pandemic on the training of clinical students at MRRH. It is for this reason that the researcher felt that there are gaps which need special attention to improve the situation. This research focused on addressing these gaps.
Summary of Key Findings
The effects of COVID 19 on the training of clinical students cannot be over emphasized in training institutions this is because this affects the nature and quality of health worker. The main objective of this study was to determine the effect of COVID 19 pandemic on the training of clinical students at MRRH in eastern Uganda. The study came up with a number of important findings that should be taken up by health institutions and other institutions in the design or overhaul of their study programs. First, the research established that COVID 19 pandemic effected clinical students academically, socioeconomically and psychologically. Secondly, the study also established factors that affect the training of clinical students, these factors were based on their effect to anxiety which was the outcome variable. These factors included; Gender, course offered employment status, comfort in the community and academic effect. Finally; it was observed that anxiety among clinical students was greatly affected by employment status of the clinical student and the level of academic effect. The analysis of the results revealed that although means of continuity of academic progress was available after a given period into the lockdown in form of online studies, LMS not all clinical students were able to take part in these sessions.