Medical students
There was a total of 179 medical student respondents to the survey. The overwhelming majority of medical student respondents were enrolled in dual-degree training programs (n = 165, 92%). There was a relatively balanced representation of trainees across all four clinical years of medical school (MS) (MS1, n = 69, 39%; MS2, n = 54, 30%; MS3, n = 18, 10%; MS4, n = 38, 21%) and between public (n = 77, 43%) and private institutions (n = 102, 57%). Demographics of survey respondents are listed in Table 1.
A total of 152 (85%) of MS respondents self-identified as being significantly stressed by the COVID-19 pandemic. Stressed respondents were more likely to be single or unmarried; however, they did not otherwise differ demographically or geographically from the non-stressed group. Stressed respondents were less likely to attend a public institution (n = 61, 40.1% vs n = 16, 61.5%, p = 0.042) and describe their medical training as being affected by the conversion to a virtual format for educational activities and advisor meetings (n = 115, 75.7% vs n = 14, 53.8%, p = 0.021). Time allocation during COVID-19 varied between stressed and non-stressed respondents, with the former describing less time spent on clinical duties (> 45% clinical time, n = 59, 38.8% vs n = 18, 69.2%, p = 0.004) and personal time (> 45% personal time, n = 10, 6.6% vs n = 5, 19.2%, p = 0.048). Stressed respondents described multiple ways in which their personal lives were adversely affected, including working from home (n = 89, 58.6% vs n = 7, 26.9%, p = 0.003), being physically isolated from friends/family due to work (n = 91, 59.9% vs n = 7, 26.9%, p = 0.002), and spending less time with partner (n = 54, 35.5% vs n = 15, 57.7%, p = 0.032) (Table 1 and Supplemental Table 1).
In a multivariate model for the outcome of stress, those who were working from home (OR 2.42, 1.15–5.22, p = 0.021), those who indicated their productivity will be negatively affected in the long term (OR 2.63, 1.07–7.14, p = 0.043) and those worrying about the health of family and friends (OR 2.97, 1.43–6.34, p = 0.004) were more likely to report increased stressed during the COVID-19 pandemic (Fig. 1a). The perception that virtual encounters are as good as in-person encounters for medical training was protective against stress among MS respondents (OR 0.18, 0.03–0.82, p = 0.035) (Fig. 1a).
Regarding productivity, a total of 117 (65%) MS respondents described their productivity as being adversely impacted by the pandemic (Table 2, Supplemental Table 1). A greater proportion of these trainees described working from home (n = 71, 60.7% vs n = 14, 35.9%, p = 0.007), being physically isolated from friends/family due to work (n = 71, 60.7% vs n = 16, 41%, p = 0.032), and being concerned with personal health (n = 90, 76.9% vs n = 21, 53.8%, p = 0.006) despite a 99% vaccination rate against COVID-19 in this cohort. Respondents with greater loss of productivity were also less likely to describe spending time preparing grant/fellowship applications (n = 4, 3.4% vs n = 5, 12.8%, p = 0.044) and working on collaborative projects (n = 21, 17.9% vs n = 13, 33.3%, p = 0.044). Consequently, this cohort expressed greater concerns regarding the negative impact of COVID-19 on the timeliness of graduation (n = 66, 56.4% vs n = 5, 12.8%, p < 0.001). Other concerns expressed in this cohort included personal health, social isolation, and financial consequence of the pandemic. Unsurprisingly, the overwhelming majority of trainees with impaired productivity self-identified as being significantly stressed (n = 108, 92.3% vs n = 27, 69.2%, p < 0.001) and with only a minority describing being optimistic about the future (n = 39, 33.3% vs n = 22, 56.4%, p = 0.019). (Table 2)
In a multivariate regression analysis for the outcome of impaired productivity, being at a public institution (OR 0.18, 0.07–0.44, p < 0.001), living by oneself (OR 0.15, 0.05–0.44, p < 0.001), having a high proportion of time (> 45%) spent on personal time (OR 0.16, 0.03–0.76, p = 0.027) were associated with a reduction in expressing impaired productivity. Having medical training delayed or clerkships canceled (OR 6.07, 1.82–23.68, p = 0.005), having personal health become a higher personal priority since the pandemic (OR 3.17, 1.27–8.24, p = 0.015), spending time taking online courses to enhance skills (OR 4.05, 1.38–13.47, p = 0.015), not having medical training compromised (OR 5.53, 2.11–16.08, p < 0.001) or saying social isolation is a source of stress (OR 3.32, 1.34–8.58, p = 0.011) were associated with impaired productivity (Fig. 1b).
In terms of optimism, female respondents were significantly less likely to report being optimistic than their male counterparts (n = 25, 37.9% vs n = 32, 64%, p = 0.005) (Table 3). Other than gender, the optimistic and non-optimistic cohorts did not differ by any other demographic or training characteristics. Respondents who were less optimistic were more likely to attribute feelings of stress, anxiety, and hopelessness due to the pandemic (n = 27, 40.9% vs n = 30, 60%, p = 0.042), describe depressive symptoms such as problems with sleep, fatigue, and changes in appetite (n = 25, 37.9% vs n = 30, 60%, p = 0.018), and report concern for the health of their friends and family (n = 34, 51.5% vs n = 37, 74%, p = 0.014) (Table 3). Of note, respondents who were less optimistic about the pandemic also described feeling stress due to many of the policy and political efforts in response to the pandemic, including concern regarding health disparities and gender inequity (n = 38, 57.6% vs n = 40, 80%, p = 0.011), and how the pandemic was managed at the local and national levels. Finally, there was greater concern regarding the potential long-term impact of COVID-19 on the careers and personal lives of those who were less optimistic about the pandemic (n = 22, 33.3% vs n = 33, 66%, p = < 0.001) See table 2 for characteristics of those who were more optimistic (Table 2).
By multivariate regression, those who expressed worry about the long-term effects of COVID-19 on career, personal life or on family/friends were less likely to be optimistic about the future (OR 0.38, 0.18–0.81, p = 0.013). Those who were male (OR 2.07, 1.01–4.29, p = 0.047), those who were spending time helping with COVID-19 related research (OR 4.77, 1.61–15.14, p = 0.006) and those indicating that their medical training has not been compromised (OR 2.34, 1.1–5.14, p = 0.03) were more likely to be optimistic about the future (Fig. 1c).
Graduate students
A total of 319 respondents were in graduate school (GS). The majority of GS respondents were part of a dual-degree program (n = 305, 96%). Most respondents described working in a wet lab (n = 264, 82.8%). Fields of study represented included biological sciences (n = 279, 87.5%); computer and information science and engineering (n = 27, 8.5%); mathematical and physical sciences (n = 24, 7.5%); and social, behavioral, and economic sciences (n = 20, 6.3%). Forty-seven (14.7%) respondents were conducting COVID-19 related research. Remaining respondent characteristics are included in Table 1, Table 2, Supplemental Table 1.
Most respondents indicated that research/scholarly activities took up the majority of their time (n = 262, 82%) (Supplemental Table 2). However, in addition to research, GS respondents reported spending more time with friends/family (n = 214, 67.1%); on personal health (n = 197, 61.8%); with partners (n = 154, 48.3%); on exercise (n = 128, 40.1%); on hobbies (n = 116, 36.4%); on research (n = 77, 24.1%); on career success activities (n = 80, 25.1%) during the pandemic. The top five research activities were data analysis and experimental design (n = 284, 89%); reading scientific literature (n = 272, 85.3%); preparing manuscript drafts (n = 188, 58.6%); preparing grant, fellowship, or faculty applications (n = 151, 47.3%); preparing research seminars and/or posters for meetings or conferences (n = 118, 37%) (Supplemental Table 1).
The COVID-19 pandemic produced several academic and social stressors for this population. More than half of the respondents noted that they worry about the long-term effects that COVID-19 will have on their career, personal life, and/or family/friends (n = 172, 53.9%). One-third of respondents (n = 106, 33.2%) had their lab shut down, while 80.6% (n = 257) had experiments delayed or impaired and 11.6% (n = 37) were unable to perform any research activities. Important milestones were postponed: 41 (12.9%) respondents had their qualifying or thesis exam postponed and 45 (14.1%) had their transition back to medical school delayed. 74% of respondents (n = 236) agreed that their research productivity and/or medical training was being negatively impacted in the short-term, and 49.8% (n = 159) believed that it would affect their career in the long-term. Almost two-thirds of the respondents experienced a significant amount of stress, anxiety, hopelessness and/or depression (n = 201, 63%). This included 191 (54.5%) who reported sleep problems, decreased energy, changes in appetite, difficulty concentrating and/or restlessness (Supplemental Table 1).
In a multivariate regression analysis, those who indicated spending time enhancing career development through online resources were less likely to be stressed (OR 0.38, 0.18–0.82, p = 0.012). Those who were dual degree students (OR 3.69, 1.09–12.47, p = 0.033) or those who were physically isolated due to work (OR 4.45, 2.39–8.62, p = < 0.001) were more likely to be stressed (Fig. 2a).
In addition to affecting trainee stress levels, the COVID-19 pandemic had a significant and negative impact on GS training, productivity, and career development. The vast majority of students felt that virtual classrooms failed to adequately recapitulate in-person learning (83.5%, n = 248). While the majority of students reported that their labs did not shut down (65.0%, n = 193), most students did report that experiments were delayed due to the COVID-19 pandemic (82.2%, n = 244). Nearly all GS respondents felt that their research productivity would be impacted in the short term (79.5%, n = 236), and a significant proportion also felt that this impact would extend into the long-term (53.5%, n = 159) (Supplemental Table 1).
In a multivariate analysis, having to isolate from family, roommates, and/or partners due to being exposed to COVID-19 (OR 0.12, 0.02–0.79, p = 0.024), spending time performing computational modeling (OR 0.26, 0.11–0.59, p = 0.001) and spending time helping with COVID-19 related research (OR 0.26, 0.11–0.61, p = 0.002) were each associated with not having impaired productivity. Labs being shut down (OR 4.16, 1.79–10.75, p = 0.002), experiments being delayed/impaired (OR 2.95, 1.4–6.26, p = 0.005), physically isolating from friends/family due to work (OR 4.99, 2.46–10.64, p = < 0.001), and personal life being affected were associated with impaired productivity (Fig. 2b).
Interestingly, the COVID-19 pandemic had a significant effect on GS research topic of choice or intended career path for a subset of respondents. Thirty-one (9.7%) respondents shifted their research efforts to COVID-19 related topics, while twenty-six (8.2%) shifted their intended career path due to the pandemic. Expectedly, the overwhelming majority of students whose productivity was adversely effected reported as being stressed by the pandemic (90.4%, n = 224). Consistent with the stress and encumbered productivity among GS respondents, only 121 (55%) of students reported feeling optimistic (Table 3). In a multivariate analysis, being at a public institution (OR 1.98, 1.21–3.27, p = 0.007) and spending time performing computational modeling (OR 2.14, 1.15-4.0, p = 0.016) were associated with optimism for the future (Fig. 2c).
Resident, Fellow, Junior Faculty (RFJF)
We received 178 responses from physician-scientists in post-graduate medical training and early career faculty positions, with an average age of 35.7 ± 5.7 years (range 19–51), 51% women, 9% Hispanic/Latino(a), and 3% Black/African American. Of note, the proportion of respondents for the latter two groups is similar to their proportion among MD-PhD graduates during this period.4 Among respondents, 74% were married or had a committed partner, and 48% had children. Completion of a formal dual degree training was reported in 60% of respondents, which is a significantly smaller proportion than represented amongst our medical and graduate student respondents (p < 0.001), while 23% were in a tenure track position (Table 1 and Supplemental Table 1).
Factors most predictive of stress during the pandemic, and which were reported by 85% of subjects, included research laboratory shutting down (OR 5.14, 1.27–35.11, p = 0.043), attending laboratory meetings virtually (OR 3.7, 1.59–9.33, p = 0.004), and worry about personal health (OR 2.42, 1.05–5.75, p = 0.041) (Fig. 3a). Protective factors included Chinese ethnicity (OR 0.21, 0.05–0.75, p = 0.017), and keeping in touch with friends and family via a virtual platform (OR 0.37, 0.15–0.86, p = 0.026). Collectively, these factors predict 88.8% of stress reported by RFJF during the COVID-19 pandemic.
Productivity impairment was described by 78% of RFJF respondents. A major contributor to decreased productivity included barriers to physical access to research facilities, including closure of campus libraries (OR 30.4, 5.08–367; p = 0.001), shutting down of research laboratories (OR 21.43, 2.4–567, p = 0.021), and working primarily in a wet laboratory setting (OR 2.8, 1.07–7.81, p = 0.041). Interestingly, homeschooling children (OR 0.09, 0.01–0.45, p = 0.005) and involvement in patient care (OR 0.35, 0.12–0.89, p = 0.034) were predictive of less reported impairment in productivity during the pandemic. Taken together, these factors predict 84.7% of the reported productivity impairment (Fig. 3b).
RFJF respondents were much more likely to be optimistic about the future if they reported not being worried about the long-term effects of covid-19 on their career, personal life, or family and friends (OR 5.14, 2.36–11.76, p < 0.001), and if they were not specialized in hematology/oncology (OR 6.01, 1.53–40.54, p = 0.025) (Table 3, Fig. 3c). Finally, we found that respondents at every level of physician-scientist training and early career reported prioritization of friends/family (66%), personal health 62%, time with partner (48%) and exercise (40%), whereas career success was reported by only 25% and research by 24% of respondents (Fig. 4).