Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. May 25, 2022; 11(3): 150-169
Published online May 25, 2022. doi: 10.5501/wjv.v11.i3.150
Educational, psychosocial, and clinical impact of SARS-CoV-2 (COVID-19) pandemic on medical students in the United States
Veronica Frank, Anjali Doshi, Natalie L Demirjian, Brandon K K Fields, Catherine Song, Xiaomeng Lei, Sravanthi Reddy, Bhushan Desai, Drayton C Harvey, Steven Cen, Ali Gholamrezanezhad
Veronica Frank, Semmelweis University Faculty of Medicine, Semmelweis University Faculty of Medicine, Budapest 1085, Hungary
Anjali Doshi, Brandon K K Fields, Catherine Song, Drayton C Harvey, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
Natalie L Demirjian, Department of Integrative Anatomical Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
Xiaomeng Lei, Sravanthi Reddy, Bhushan Desai, Steven Cen, Ali Gholamrezanezhad, Department of Radiology, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
Author contributions: Doshi A and Frank V drafted the survey for the present study; Doshi A managed the survey edits, coding the survey, and submission; Desai B obtained IRB approval; Demirjian NL, Fields BKK, and Song C assisted in survey question editing rephrasing; Desai B, Reddy S, and Gholamrezanezhad A reviewed study documents, survey modifications, and provided input; Doshi A, Frank V, Demirjian NL, Fields BKK, Harvey DC facilitated network outreach; Lei X and Cen S performed statistical analysis on the data; Doshi A and Frank V drafted the manuscript. Prior to submission all authors provided edits; Doshi A and Frank V equally contributed to the work.
Institutional review board statement: The Institutional Review Board of USC determined this study to be exempt from review (application number UP-20-00314).
Informed consent statement: The study was a survey, for which informed consent was waived by IRB, as no clinical or identifying information from the participants were recorded.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali Gholamrezanezhad, MD, Associate Professor, Department of Radiology, Keck School of Medicine of University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033, United States. a.gholamrezanezhad@yahoo.com
Received: December 17, 2021
Peer-review started: December 17, 2021
First decision: February 21, 2022
Revised: March 10, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: May 25, 2022
Abstract
BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic altered education, exams, and residency applications for United States medical students.

AIM

To determine the specific impact of the pandemic on US medical students and its correlation to their anxiety levels.

METHODS

An 81-question survey was distributed via email, Facebook and social media groups using REDCapTM. To investigate risk factors associated with elevated anxiety level, we dichotomized the 1-10 anxiety score into low (≤ 5) and high (≥ 6). This cut point represents the 25th percentile. There were 90 (29%) shown as low anxiety and 219 (71%) as high anxiety. For descriptive analyses, we used contingency tables by anxiety categories for categorical measurements with chi square test, or mean ± STD for continuous measurements followed by t-test or Wilcoxson rank sum test depending on data normality. Least Absolute Shrinkage and Selection Operator was used to select important predictors for the final multivariate model. Hierarchical Poisson regression model was used to fit the final multivariate model by considering the nested data structure of students clustered within State.

RESULTS

397 medical students from 29 states were analyzed. Approximately half of respondents reported feeling depressed since the pandemic onset. 62% of participants rated 7 or higher out of 10 when asked about anxiety levels. Stressors correlated with higher anxiety scores included “concern about being unable to complete exams or rotations if contracting COVID-19” (RR 1.34; 95%CI: 1.05-1.72, P = 0.02) and the use of mental health services such as a “psychiatrist” (RR 1.18; 95%CI: 1.01-1.3, P = 0.04). However, those students living in cities that limited restaurant operations to exclusively takeout or delivery as the only measure of implementing social distancing (RR 0.64; 95%CI: 0.49-0.82, P < 0.01) and those who selected “does not apply” for financial assistance available if needed (RR 0.83; 95%CI: 0.66-0.98, P = 0.03) were less likely to have a high anxiety.

CONCLUSION

COVID-19 significantly impacted medical students in numerous ways. Medical student education and clinical readiness were reduced, and anxiety levels increased. It is vital that medical students receive support as they become physicians. Further research should be conducted on training medical students in telemedicine to better prepare students in the future for pandemic planning and virtual healthcare.

Keywords: Medical student, SARS-CoV-2, Anxiety, Stress, Psychological, Impact clinical

Core Tip: The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) pandemic resulted in a significant impact on medical student education. Education was switched to on-line, examinations were changed, and students’ faced dismissal from hospital wards. In this study we analyzed the unique stressors that resulted in higher anxiety levels in medical students. From the results, we can agree that the development of medical school curricula for public health and mass casualty planning as well as providing further mental health support for medical students is necessary and should be further studied.