Of 2511 students contacted, we received 741 responses (29.5% response rate). Of these, 63.9% of respondents were female and 35.1% were male, with 1.0% reporting a different gender identity; 27.7% of responses came from the class of 2020, 53.5% from the class of 2021, and 18.7% from the class of 2022. (Demographics, Table 1)
Table 1. Demographics
|
20-24
|
25-29
|
30-34
|
35-39
|
40-44
|
45+
|
Age n (%)
|
87 (12.5%)
|
493 (70.9%)
|
98 (14.1%)
|
14 (2.0%)
|
1 (0.1%)
|
2 (0.3%)
|
|
Male
|
Female
|
Trans Male
|
Trans Female
|
Genderqueer/ Nonbinary
|
Other
|
Gender* n (%)
|
242 (35.1%)
|
443 (63.9%)
|
1 (0.1%)
|
0 (0.0%)
|
8 (1.2%)
|
2 (0.3%)
|
|
|
|
|
|
|
|
|
African-American
|
Asian
|
Hispanic/
Latinx
|
Native American/ American Indian
|
Native Hawaiian/ Pacific Islander
|
White
|
Other
|
Race/Ethnicity* n (%)
|
42
(6.1%)
|
199 (29.1%)
|
77
(11.2%)
|
5
(0.7%)
|
1
(0.1%)
|
408 (59.6%)
|
36
(5.3%)
|
|
2020
|
2021
|
2022
|
Graduation Year† n (%)
|
193 (27.8%)
|
372 (53.5%)
|
130 (18.7%)
|
|
West
|
Midwest
|
South
|
East
|
US Region n (%)
|
290 (41.8%)
|
114 (16.4%)
|
176 (25.3%)
|
110 (15.9%)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
*allowed students to select more than one response †excluding any planned time off
Most student respondents (74.9%) had a clinical rotation that was cut short or canceled due to COVID-19 and 93.7% reported not being involved in clinical rotations with in-person patient contact at the time of the study. Regarding students’ perceptions of cancelled rotations (allowing for multiple reactions), 75.8% felt this was appropriate, 34.7% felt guilty, 33.5% felt disappointed, and 27.0% felt relieved.
Most students (74.7%) agreed that their medical education had been significantly disrupted by the pandemic. Students also felt they were able to find meaningful learning experiences during the pandemic (72.1%). Free response examples included: taking a novel COVID-19 pandemic elective course, telehealth patient care, clinical rotations transitioned to virtual online courses, research or education electives, clinical and non-clinical COVID-19-related volunteering, and self-guided independent study electives. Students felt their medical schools were doing everything they could to help students adjust (72.7%). Overall, respondents felt the pandemic had interfered with their ability to develop skills needed to prepare for residency (61.4%), though fewer (45.7%) felt it had interfered with their ability to apply to residency. (Educational Impact, Figure 1)
A majority of medical students agreed they should be allowed to continue with normal clinical rotations during this pandemic (61.3%). Most students agreed (83.4%) that they accepted the risk of being infected with COVID-19, if they returned. When asked if students should be allowed to volunteer in clinical settings even if there is not a healthcare worker (HCW) shortage, 63.5% agreed; however, in the case of a HCW shortage only 19.5% believed students should be required to volunteer clinically. (Willingness to Participate Clinically, Figure 2)
When asked if they perceived a moral, ethical, or professional obligation for medical students to help, 37.8% agreed that medical students have such an obligation during the current pandemic. This is in contrast to their perceptions of physicians: 87.1% of students agreed with a physician obligation to help during the COVID-19 pandemic. For both groups, students were asked if this obligation persisted without adequate PPE: only 10.9% of students believed medical students had this obligation, while 34.0% agreed physicians had this obligation. (Ethical Obligation, Figure 3)
Given the assumption that there will not be a COVID-19 vaccine until 2021, students felt the single most important factor in a safe return to clinical rotations was having access to adequate PPE (53.3%), followed by adequate testing for infection (19.3%) and antibody testing for possible immunity (16.2%). Few students (5%) stated that nothing would make them feel comfortable until a vaccine is available. On a 1-7 scale (1=not at all, 4=somewhat, 7=extremely), students felt somewhat prepared to use PPE during this pandemic in the clinical setting, median = 4 (IQR 4,6), and somewhat confident identifying symptoms most concerning for COVID-19, median = 4 (IQR 4,5). Students preferred to learn about PPE via video demonstration (76.7%), online modules (47.7%), and in-person or Zoom style conferences (44.7%).
Students believed they were likely to contract COVID-19 in general (75.6%), independent of a return to the clinical environment. Most respondents believed that missing some school or work would be a likely outcome (90.5%), and only a minority of students believed that hospitalization (22.1%) or death (4.3%) was slightly, moderately, or extremely likely.
On a 1-7 scale (1=not at all, 4=somewhat, and 7=extremely), the median (IQR) reported effect of the COVID-19 pandemic on students’ stress or anxiety level was 5 (4,6) with 84.1% of respondents feeling at least somewhat anxious due to the pandemic. Students’ perceived emotional exhaustion and burnout before the pandemic was a median = 3 (IQR 2,4) and since the pandemic started a median = 4 (IQR 3,5) with a median difference Δ = 1, p value <0.001.
Secondary analysis of key questions revealed statistical differences between sub-groups. Women were significantly more likely than men to agree that the pandemic had affected their anxiety. Several significant differences existed for the class of 2020 when compared to the classes of 2021 and 2022: they were less likely to report disruptions to their education, to prefer to return to rotations, and to report an effect on anxiety. There were no significant differences with students who were still involved with in-person patient care compared with those who were not. In comparing areas with high COVID-19 prevalence at the time of the survey (New York and Louisiana) with medium (Illinois and Ohio) and low prevalence (California), students were less likely to report that the pandemic had disrupted their education and to agree that medical students should return to rotations. There were no differences between prevalence groups in accepting the risk of infection to return, or the effect of the pandemic on anxiety levels. (Stratification, Table 2)
Table 2. Stratification
Agreement with the following statements
|
Total n
|
My medical education has been significantly disrupted by the pandemic
|
To the extent possible, medical students should continue with normal clinical rotations during this pandemic
|
I accept the risk that I may be infected with COVID-19 if I return to the clinical setting in 2020
|
How much has the COVID-19 pandemic affected your stress or anxiety levels?
|
|
|
# agreeing/# of Respondents (%)
|
p
|
# agreeing/# of Respondents (%)
|
p
|
# agreeing/# of Respondents (%)
|
p
|
# agreeing/# of Respondents (%)
|
p
|
All respondents
|
741
|
520/696 (74.7)
|
|
425/693 (61.3)
|
|
579/694 (83.4)
|
|
619/736 (84.1)
|
|
Gender
|
|
|
|
|
|
|
|
|
|
Female
|
443
|
332/442 (75.1)
|
0.78
|
273/440 (62.1)
|
0.87
|
375/440 (85.2)
|
0.25
|
394/439 (89.8)
|
<0.001
|
Male
|
243
|
184/242 (76.0)
|
|
148/241 (61.4)
|
|
198/242 (81.8)
|
|
177/242 (73.1)
|
|
Graduation Class
|
|
|
|
|
|
|
|
|
|
2020
|
193
|
74/191 (38.7)
|
<0.001
|
92/190 (48.4)
|
<0.001
|
167/190 (87.9)
|
0.049
|
146/191 (76.4)
|
0.003
|
2021
|
372
|
332/371 (89.5)
|
|
240/371 (64.7)
|
|
299/371 (80.6)
|
|
320/369 (86.7)
|
|
2022
|
130
|
111/130 (85.4)
|
|
92/128 (71.9)
|
|
112/129 (86.8)
|
|
114/130 (87.7)
|
|
COVID-19 prevalence
|
|
|
|
|
|
|
|
|
|
High (NY,LA)
|
288
|
196/286 (68.5)
|
<0.001
|
169/285 (59.3)
|
0.019
|
238/285 (83.5)
|
0.82
|
239/288 (83.0)
|
0.58
|
Medium (OH,IL)
|
111
|
98/111 (88.3)
|
|
58/110 (52.7)
|
|
91/111 (82.0)
|
|
96/110 (87.3)
|
|
Low (CA)
|
292
|
220/292 (75.3)
|
|
195/291 (67.0)
|
|
246/291 (84.5)
|
|
242 /288(84.0)
|
|
Were on clinical rotations at time of study
|
|
|
|
|
|
|
|
|
|
Yes
|
47
|
34/41 (82.9)
|
0.21
|
31/41 (75.6)
|
0.053
|
35/41 (85.4)
|
0.73
|
39/47 (83.0)
|
0.83
|
No
|
694
|
486/655 (74.2)
|
|
394/652 (60.4)
|
|
544/653 (83.3)
|
|
580/689 (84.2)
|
|