The main message
Our study indicates that the COVID-19 pandemic has impacted the lifestyle, behaviors, emotions, feelings, and educational experiences of healthcare students at our university. Results show both negative and positive impact, but negative changes were more commonly observed, including decreased physical activity, worsened diet, increased negative emotions and feelings, and perceived disruption. in education with the move to online teaching.
Perspective
It is well documented that the prevalence of depression, depressive symptoms, and suicidal ideation is higher among medical students, as reported pre-COVID-19 in a systematic literature review and meta-analysis by Rotenstein, et al. (2016) (16). However, since the pandemic, voluntary declarations from medical students, as in our study, suggest a further increase in these pathologies. Our study’s mental health findings are consistent with other recent international studies. In a prospective Indian longitudinal study of 217 medical students, Saraswathi, et al. (2020) found that the COVID-19 pandemic appeared to negatively affect the mental health of their students, with the prevalence and levels of anxiety and stress increasing, but symptoms of depression remaining unchanged (ten). In a large cross-sectional, survey-based study stratified by region conducted in China by Ye, et al. (2020), demographic data and mental measures were collected from 2,498 medical students and 1,177 non-medical students in 31 provinces. They found that medical students suffered more stress than non-medical students in almost all provinces of China (11). Conversely, in a cross-sectional study conducted by Nakhostin-Ansari among Iranian medical students, et al. (2020) found that although depression and anxiety were prevalent during the pandemic, they did not differ significantly among their students before and after the COVID-19 outbreak. They hypothesized that minimizing students’ presence in clinical settings and their exposure to COVID-19 patients might have helped control anxiety symptoms (12).
Studies of nursing students have found similar results. In a cross-sectional study conducted by Wang among 586 nurses in eastern China, et al. (2021) The prevalence of anxiety and depression among nurses during the pandemic was 27.6% and 32.8%, respectively (13). A large study of 1,485 medical and dental students in the United Arab Emirates by Saddik, et al. (2020) showed that medical students have lower levels of anxiety during the pandemic than dental students, although this level became higher during clinical rotations and decreased once virtual learning was introduced (14). But despite these pandemic concerns, studies show a high level of interest and understanding about COVID-19 and healthcare students are still seen as important ambassadors and activists for control measures infections, particularly in countries where medical education has been suspended, with many recognizing their responsibility to their community as volunteers as well as the importance and risks of their chosen profession (17, 18).
There are few studies that specifically examine changes in lifestyle and habits due to the pandemic, but none among healthcare students. In a cross-sectional online survey in Saudi Arabia of 280 children aged 6 to 15 years, Hanbazaza and Wazzan (2021) provide evidence of the negative influences of the COVID-19 curfew on health-related behaviors, including eating habits, physical activity and sedentary lifestyle. behavior (19). Similarly, in an online questionnaire of 1,048 South African adults, Lewis, et al. (2021) showed in their population that low physical activity related to COVID-19 predicted greater severity of insomnia symptoms, which in turn predicted increased depressive and anxiety-related symptoms. Overall, the relationships between study variables and mental health outcomes were amplified during lockdown. The findings highlight the importance of maintaining physical activity and reducing sedentary screen use to promote better sleep and mental health (20). Our study reflects these changes, with most students reporting a deterioration in their diet and a reduction in the amount of physical exercise they engage in. It is therefore likely that these changes are linked to the increase in their levels of anxiety and depression.
In terms of education, the closure of schools and universities, including all medical schools in the UK, has led to the cessation of live classes in conventional lecture theaters and the cancellation of clinical placements . However, there are innovative methods of delivering education to minimize this disruption to training, with a move toward distance education including online webinars on various platforms such as Zoom (Zoom Video Communications, Inc., San Jose, California, United States) and open books online. exams (21). Virtual and e-learning-based medical education, including multimedia study materials and virtual surgery electives, has proven to be extremely essential in providing acceptable training to undergraduate medical students during an epidemic. to ensure that satisfactory training standards are maintained (22,23,24). Service-learning, an internationally implemented form of experiential education in undergraduate primary care, with the potential to significantly improve clinical practice while simultaneously facilitating medical student learning , is also an example of a new learning model that will continue to gain traction in the post-COVID era (25).
Overall, our results showed that medical students did not believe their education was as negatively impacted as other students. Interestingly, a large proportion of medical students strongly disagreed with the idea of dropping their course, while other students’ responses were more evenly distributed across all options. This difference could be explained by differences in motivation and learning strategies among medical students who tend to focus on lifelong learning (26, 27). The majority of medical students also seem to disagree that online teaching has offset face-to-face teaching, but agree that online teaching still has a role to play in the standard curriculum. The general consensus for other students was less clear.
It is clear from our data that students at our institution are experiencing difficulties at different levels. While previously, university studies could be complemented by collaborative learning or a relaxed social life at university, the COVID-19 pandemic along with social distancing rules have resulted in a very isolated lifestyle. Health care students are particularly sensitive to these changes because their training depends on interpersonal interactions, in the form of internships and clinical skills sessions. Restrictive measures imposed on healthcare students due to the threat of COVID-19 have deprived many of the joys of university life (6). More needs to be done to ensure that these students receive adequate support during the lockdown, for example by ensuring the availability of robust and imaginative learning opportunities for students, providing them with opportunities to contribute to the pandemic response and by guaranteeing access to pastoral care. Bye, et al. (2015) show that among medical students, only a third experiencing burnout will seek help due to the associated stigma, negative personal experiences, and hidden curriculum, all of which contribute (28). Based on our data, we suggest that this may be true for students across all health care disciplines at our institution.
Limitations of this study
This study is limited to data from a single university and therefore only reflects the student population present at that particular institution. However, recently published studies examining the same variables in different institutions and countries show similar results to those in this article and, anecdotally, these sentiments have been expressed by students at other universities, both in the press and on social media platforms.
We studied a heterogeneous sample with participants of different ages and educational backgrounds, which we believe makes our results more generalizable. The characteristics of the participants may have influenced the impact of the pandemic on them. For example, being a graduate student may have allowed them to better manage stress. Separating the data or performing subgroup analyzes would have allowed us to identify these variables but given the relatively small numbers, we decided to limit our analysis to the group as a whole.
The response rate was low, but comparable to other published studies and we believe it still provides an extremely useful snapshot of the pandemic’s effect on the student body.
This study did not ask students to justify their emotions or feelings, nor did it examine what they were doing during the pandemic, such as whether they were volunteering at a health care setting or whether they were confined alone or with others. These factors may have impacted their survey responses.
