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Table of Contents
ORIGINAL ARTICLES
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 33-40

Medical student and faculty perceptions of the COVID-19 pandemic on medical education and personal well-being


1 Department of Obstetrics and Gynecology, University of California, Riverside, CA, USA
2 School of Medicine, University of California, Riverside, CA, USA
3 Department of Psychology, University of California, Riverside, CA, USA

Date of Submission17-Mar-2022
Date of Acceptance01-Jun-2022
Date of Web Publication09-Sep-2022

Correspondence Address:
Dr. Janet Cruz
19330 Jesse Lane, Riverside, CA 92508
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/EHP.EHP_7_22

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  Abstract 

Objective: This is a retrospective questionnaire study, which aims to highlight the effects COVID-19 has had on medical education and personal well-being on medical students and faculty. Materials and Methods: An email containing two questionnaire links, one for medical students and the other for clinical faculty, was sent to medical institutions in California. The medical student questionnaire consists of 18 questions, and the faculty questionnaire consists of 15 questions. Results: The total number of participants who responded was 213; 160 were medical students and 44 were faculty. Forty-seven percent of medical students believe that their medical education has been negatively affected by the pandemic, and 49% strongly agree that lack of in-person communication has negatively affected medical education. Fifty-two percent of faculty indicated that they strongly agree medical education at their institution, which has been negatively affected by the COVID-19 pandemic; 46% somewhat agree that lack of in-person communication has negatively affected clinical education. Conclusion: Both faculty and medical students reported a decline in the quality of medical education, satisfaction, competency, and personal well-being during the pandemic. The COVID-19 pandemic is ongoing and institutions must adopt a virtual interactive curriculum to improve both education and mental health.

Keywords: COVID-19 pandemic, medical education, mental health, remote learning


How to cite this article:
Cruz J, Devito J, Cheung C, Vasireddy A, Stuparich MA, Nahas S, Behbehani S. Medical student and faculty perceptions of the COVID-19 pandemic on medical education and personal well-being. Educ Health Prof 2022;5:33-40

How to cite this URL:
Cruz J, Devito J, Cheung C, Vasireddy A, Stuparich MA, Nahas S, Behbehani S. Medical student and faculty perceptions of the COVID-19 pandemic on medical education and personal well-being. Educ Health Prof [serial online] 2022 [cited 2022 Oct 7];5:33-40. Available from: https://www.ehpjournal.com/text.asp?2022/5/2/33/355840




  Introduction Top


Medical training can be a stressful time for any medical student, especially during a global emergency. The emergence of coronavirus disease 2019 (COVID-19) has interrupted medical education and required immediate attention from medical educators.[1],[2] Medical education faculty have rapidly transitioned pre-clerkship and clerkship curricula to online formats in response to the pandemic, and the necessity to prepare future physicians has never been as important. The effects of the COVID-19 pandemic on medical education will forever change how medical students are educated and have not yet been studied.

For decades, medical institutions have transformed education by eliminating and/or reducing lectures, using technology to enhance anatomy and laboratories, implementing team-facilitated, active, and self-directed learning, and prompting individualized and interprofessional education.[3],[4] As described by Mooney and Bligh,[3] online learning provides students with easier and more effective access to a greater variety and quantity of information, improving medical education overall. However, the transition from a traditional form of teaching to use of online modalities and distance learning is not without challenges as cultural resistance among staff has previously been identified as a barrier.[5] Based on 86 studies using over 15,000 participating students, the results of a meta-analysis by Shachar and Neumann show a strong positive trend, indicating that distance learning is an effective form of instruction.[6] These results propose that distance learning may be a feasible option for education, especially during an unprecedented time where online distance learning is our main approach for medical education.

The purpose of this study is to investigate the effects of COVID-19 on medical education and personal well-being of both medical students and faculty and to compare results between medical students and faculty. Data will investigate whether online learning modalities were used and whether medical students and/or faculty believe that it is comparable to medical education before the quarantine. With these data, the perception of medical education during the COVID-19 era may be assessed for quality and effectiveness and potentially promotes distance learning as an appropriate resource for medical education.


  Materials and Methods Top


An email containing the two questionnaire links, one for medical students and the other for clinical faculty, was sent to all 16 California medical institutions in July 2020. Medical schools in California were chosen as a sample to represent medical schools across the country. Each medical institution’s Dean of Medical Education was emailed and asked to forward the email containing the questionnaire links to all medical students and faculty. Medical students were encouraged to participate only if they were currently enrolled in that institution, and clinical faculty were encouraged to participate only if they were active in medical training during the pandemic. Weekly reminder emails were sent to the Deans of Medical Education during July and August 2020, following the first contact email. The project was reviewed and approved by the University of California, Riverside (UCR) Institutional Review Board (IRB).

The Experience Management (XM) platform via Qualtrics was accessed by UCR to formulate the two electronic versions of the questionnaires submitted and approved by the UCR IRB. The medical student questionnaire consists of 18 questions, and the faculty questionnaire consists of 15 questions (Supplementary Materials 1 and 2[Additional file 1]). The first five multiple choice questions of both surveys assessed for demographic characteristics such as medical school year/title of designation, age, gender identity, ethnicity, and medical institution; faculty were asked how many years of clinical practice they had following residency training, and medical students were asked how many months they had been pulled away from clinical rotations. Both surveys used one question to assess for symptoms of wellness such as depressed mood, sleep disturbance, decreased interest in activities, feelings of guilt or worthlessness, decreased energy, concentration difficulties, appetite disturbance or weight changes, restlessness, fatigue, irritability, and excessive worrying. The remaining questions from each survey assessed how medical students and faculty both felt about how the COVID-19 pandemic affected medical training using Likert-type scales. The questionnaires were completed anonymously, and no identifiable information was collected. Participants were allowed to stop participating anytime during the questionnaire and/or able to decline any question they did not wish to answer.

Statistical analyses were conducted to evaluate the impact of COVID-19 on personal well-being and medical education of both medical students and faculty. First, Pearson’s χ2 test was used to examine whether the reported symptoms of depression and anxiety differed between faculty and students. Among the faculty respondents, χ2 analysis was employed to test whether the number of reported symptoms depended on their post-residency status (i.e., under vs. over 10 years post-residency). Next, independent samples t-test (for responses measured on Likert scales) and χ2 test (for frequencies) were employed to compare faculty and students’ perceptions of medical education during COVID-19.


  Results Top


The survey questionnaire was distributed to all 16 California medical schools. The University of California, San Francisco and the University of Southern California Deans of Medical Education declined participation in the study. The Kaiser Permanente Tyson School of Medicine was removed from the study because they had no active medical students and faculty for the academic school year. The total number of participants who responded was 213.

One hundred and sixty were medical students and 44 were faculty. Among the medical students, 102 (60.7%) were females and 57 (33.9%) were males. Among medical students, 66.9% were in the 25–34 year age group. Thirty percent of medical students were in the 18–24 year old group. The majority of medical students who participated in this study were noted as follows: 54 (33.5%) respondents identified as Asians, 45 (28%) respondents identified as White/Caucasian, and 33 (20.5%) respondents identified as Hispanic/Latino. Among the medical students respondents, 24 (15%) were in their first year, 47 (29%) were in their second year, 48 (30%) were in their third year, and 38 (23.%) were in their fourth year [Table 1].
Table 1: Medical student baseline characteristics

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Of the 44 faculty participants, 23 (53.3%) were females and 18 (41.9%) were males. The majority of faculty members (30.2%) were in the 35–44 age group. More than half (58.1%, n = 25) of the faculty participants identified as White/Caucasian, 5 (11.6%) identified as Black/African American, and 5 (11.6%) identified as Asian. Almost one-third of faculty had more than 20 years of clinical experience (27.7%, n = 13), 12.8% (n = 6) had 11–20 years of clinical experience, and 12.8% (n = 6) had 6–10 years of clinical experience. More than half (57.4%, n = 27) of the faculty have a Medical Doctorate degree (MD), 12.8% (n = 6) have a Doctorate of Medicine and of Philosophy degree (MD and PhD), and 10.6% (n = 5) have a Doctorate of Osteopathic Medicine degree (DO) [Table 2].
Table 2: Faculty baseline characteristics

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Eighty percent of students reported that their medical school adapted to a remote learning curriculum because of the pandemic. Sixty percent of students reported that their school incorporated recorded lectures, and 84% of the students reported that their school used live online lectures. Sixty-one percent of the students conveyed that their medical school still required quizzes and examinations during the pandemic [Table 3]. When asked how long they were physically removed from clinical rotations and only using online learning modalities during the pandemic, the majority answered 3–4 months (32%).
Table 3: Reported education modalities and perception of medical education changes during the COVID-19 pandemic

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Forty-seven percent of medical students believe that their medical education has been negatively affected by the pandemic, 49% strongly agree that lack of in-person communication has negatively affected medical education, 24% somewhat agree that lack of in-person communication has negatively affected medical student communication skills, and 35% were neutral about how satisfied they were with their medical education during the pandemic. When assessing competency, 42% reported feeling partially competent with the clinical aspect of medical education, and 46% reported feeling competent with the knowledge aspect of medical education [Table 4].
Table 4: Comparing medical student and faculty perceptions of medical education during the COVID-19 pandemic (scale for questions 1-3: 1 = strongly disagree, 5 = strongly agree; scale for questions 4-5: 1 = not competent at all, 5 = very competent)

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When comparing results from medical students in the first half of their training (1st and 2nd year) to medical students in the latter half of their training (3rd and 4th year), there were differences noted in how medical education was adapted to the pandemic. The majority of medical students in this study reported that their institution adopted an electronic curriculum during the pandemic. Yet, the type of education reported was different among medical student participants based on medical school year. In this study, the majority of students in years 3–4 reported that they attended required clerkships online and that their required clerkships had exams during the pandemic. However, the majority of medical students in years 1–2 reported that they never attended any clerkships; instead, their school utilized recorded and live online lectures.

When medical students were asked to answer how satisfied they were with the medical education received during the COVID-19 pandemic, almost 50% of medical students in years 1 and 2 reported that they were satisfied in comparison to only 15% of medical students in years 3 and 4. Almost 70% of medical students in years 1–2 reported that they felt more competent with the knowledge aspect of the medical education received during the COVID-19 pandemic than almost 42% of medical students in years 3–4. Of the 39 participants who reported applying to residency in the 2020–2021 academic year, 11.8% felt that the COVID-19 pandemic has negatively affected the chance of matching into their desired specialty [Table 5].
Table 5: Medical student reported education modalities and perception of medical education changes during the COVID-19 pandemic

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When looking at reported mood symptoms, 52% of medical students expressed depressed mood, 54% expressed sleep disorder, 41% described decreased interest in activities, 26% expressed feelings of guilt/worthlessness, 47% expressed decreased energy, 66% described difficulty concentrating, 41% had decreased appetite, 43% had restlessness, 43% had fatigue, 37% expressed irritability, 52% expressed worry, and only 12% had none of the above symptoms. When comparing symptoms of depression and anxiety between the first and second year medical students vs. the third and fourth year medical students, there was no difference [Table 6].
Table 6: Symptoms of depression and anxiety based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-V

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In this study, medical students reported more symptoms of anxiety and depression during the pandemic compared with faculty. When assessing differences in symptoms of depression and anxiety based on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-V, up to one-third to one-half of medical students reported these symptoms in comparison to one-tenth to one-third of faculty.

There was no statistical difference in faculty-reported symptoms of anxiety and depression when the participant group was divided into <10 years post-residency training vs. >10 years post-residency training [Table 7]. The majority of faculty (95%) reported that they had to hold online classes, 68% had to utilize recorded lectures, 78% had to utilize live online lectures, 59% reported that required classes have exams, 61% reported that they have experienced increased fatigue with online platforms used for lectures and meetings, and only 3% reported none of the above [Table 3]. When asked to compare the quality of the online curriculum with that of the curriculum before the pandemic, the majority of faculty answered that it is of lower quality (61%), 10% reported equal quality, and only 1% reported it was of better quality [Table 3].
Table 7: Symptoms of depression and anxiety based on Diagnostic and Statistical Manual of Mental Disorders (DSM)–V in relation to years post-residency training

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Fifty-two percent of faculty indicated that they strongly agree medical education at their institution has been negatively affected by the COVID-19 pandemic, 46% somewhat agree that lack of in-person communication has negatively affected clinical education, and 46% and 49% are neutral about how competent they feel medical students are with the knowledge and clinical aspects of medical education students have received during the pandemic, respectively. Overall, the majority of faculty indicated that they feel medical students are competent with the clinical aspect of medical education received during COVID-19 (43%).

There was no difference in faculty-reported perception of medical education, reported education modalities, and barriers to educational resources during the pandemic based on years post-residency training with all faculty equally affected, irrespective of time lapsed after their training. When assessing differences of limiting barriers to medical education during the COVID-19 pandemic among faculty and medical students, responses appeared similar. Data from the study show that medical students and faculty both agree that education has been affected by the pandemic. Changes made to accommodate medical education during the pandemic were endorsed by both faculty and students. Barriers to educational resources are displayed by medical students, and faculty reported difficulties in accessing the technology and equipment required to accommodate these changes [Table 8].
Table 8: Barriers to educational resources during the COVID-19 pandemic

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  Discussion Top


Undergraduate medical training is grueling, as it comprised long, strenuous hours of study for up to 4 years.[7] Traditionally, a medical school’s curriculum is composed of 2 years of basic sciences and 2 years of clinical rotations in a teaching hospital.[2] Medical schools’ academic culture has been found to be rooted in memorization, learning clinical practice from residents with minimal supervision from overly busy practicing physicians, and for years, medical schools training has been rigorous, inflexible, overly long, and not learner-centered.[2] Hundreds of medical schools and trainees therefore also lack adaptability and are not able to easily remodel with the changing times.[4]

Because of that, a call to reform and standardize medical schools’ curriculum took place in the beginning of the twenty-first century.[2] Even prior to the COVID-19 pandemic, significant barriers to renovate today’s medical school curriculum were identified, especially with institutional rigidity and underdeveloped technology.[4]

It is clear that the COVID-19 pandemic has unquestionably changed the direction of the medical field in its healthcare delivery to become more flexible and innovated such as providing telehealth visits for patients and online learning for medical students.[8] It ultimately took a worldwide pandemic to create the innovative changes that Shachar and Neumann[6] and Skochelak and Stack[4] have promoted in their studies. The pandemic drove the medical field to finally accept telemedicine as an appropriate form of providing care and to notably restructure school curricula from in-person to remote learning to comply with social distancing recommendations.[9]

Quarantine due to the COVID-19 pandemic has caused depression, anxiety, and changes in the learning behaviors of medical students.[10] In this study, more than half of the medical students and 28.6% of faculty reported symptoms of anxiety and depression. This is in line with other studies published during the COVID-19 pandemic. Mental health and well-being are rooted in being surrounded by a functioning society as well as a stable work–life balance.[11] The COVID-19 pandemic has induced a mental health crisis as well as psychosocial experiment.[11] The demands of learning can negatively impact students’ mental health.[12] In a recent cohort study which collected questionnaires from 3348 medical students, they reported that healthy students develop depression and stress soon after commencing their medical school education.[12] The COVID-19 pandemic has isolated medical students from their family, fellow students, and friends, which can exacerbate depression and anxiety. Another recent cohort studying the mental well-being of 625 medical students during the pandemic described that medical students identified that quarantine caused them to feel emotionally detached and decreased their overall work performance.[11]

Both faculty and medical students were ill-prepared for the drastic shift to online learning as reported in this study. In this study, 61% of faculty and 49% of medical students believed that medical education was negatively affected by the pandemic, illustrating that medical schools and faculty were not comfortable with different modalities of teaching. Future incorporation of online teaching within traditional medical education will ultimately improve learning outcomes and boost confidence in both faculty and medical students. Medical schools who are able to adapt to this new technologic method of teaching will be the teaching centers of the future. They will be characterized by systems ready for and adaptable to rapid change, change in technology, in dissemination of information and data, in care delivery, and by providing environments that prepare physicians to be lifelong, adaptive learners.[4] This transition has exposed medical students to relevant telemedicine technologies and will ultimately prepare them for the present age of COVID-19 and for future pandemics. Even if medical schools are able to apply virtual learning to their curriculum, this will have the most relevant impact on the first 2 years of medical school training, which are rooted in systems-based lectures aimed at rote memorization.[6] The third and fourth years of traditional medical school training are based on clinical experiences through interactive rotations and hands-on learning as opposed to learning in a classroom. The medical students and faculty in this study endorsed this traditional format, with the majority of students in years 3–4 attending required clerkships online, whereas the majority of medical students in years 1–2 never attended any clerkships; instead, their school utilized recorded and live online lectures [Table 6].

Virtual lectures to replace inpatient clinical experience in the wards can be difficult to provide remotely. This is likely why the third and fourth year medical students reported more of a disadvantage, felt less competent, and less confident in their medical education when compared with first and second year medical students. In this study, 15.9% of the first and second year medical students felt competent regarding the education received during the pandemic, compared with only 2.4% of third and fourth year medical students. Creating a virtual curriculum that engages students will ultimately create a better psychosocial environment for the students to learn and to socialize while maintaining social distancing.[10] Developing these new models for medical schools will effectively train our next generations of physicians and optimally serve our patients and communities.[4] This will provide more confidence and competency for the third and fourth year medical students who felt a disadvantage, as shown in this study.

Advancement in technology in order to provide medical students with adequate education and patients with appropriate health care is not always feasible. Significant disparities exist that limit access to quality education and health care. In order to obtain a virtual clinical or educative experience, one must have a functioning computer or an electronic device, quality internet connection, and be proficient or adaptive to new technology.[5] Living in impoverished areas can hinder education and health outcomes.[13] Astonishingly, this study reported that 18% of the medical students and 20% of the faculty members had difficulty accessing an adequate WIFI connection during the pandemic. Eleven percent of the medical students and 11% of the faculty members had difficulty obtaining the equipment needed for online learning. In this era, it is hard to explain why our communities still have difficulty assessing the technology needed to advance in their work, education, and health. Technology is tightly embedded into our daily living and without access to the internet, underserved communities will continue to have increased poverty and disparities.[13] Implementation of programs that provide adequate technology services to underserved areas will reduce the disparities that exist and improve overall well-being by providing telemedicine to patients and virtual learning to students.

There were multiple limitations to this study. Given the survey used in this study was created for the purpose of this study, misinterpretations of the questions could have affected the results. Although a validated questionnaire currently does not exist, efforts should be made to create one that can be used in the future to assess the quality of medical education. The results of the survey represent a small sample size and may not be representative of patterns in other institutions with better technology and an adequate online curriculum. Similarly, our survey was geographically limited to medical schools in the state of California and may not be generalizable. This study could also have been limited by a response bias, with the majority of the participants being from the University of California, Riverside.

Strengths of this study include that it is one of the few studies that evaluated both faculty and medical student perceptions of online learning early in the pandemic. As this is a new transition in medical education, collecting any information, regardless of sample size, may be crucial in reconstructing the curriculum. Another strength of this study is that it compared responses between clinical faculty and medical students in relation to medical education as well as personal well-being. It also inquired about difficulty in accessing technology required for remote learning. This allows the school to assess the perception of both the students and educators, so that change can be made to better improve the education and mental health of both groups, as well as provide access to technology when required.

A future consideration is to re-survey the faculty and students now that we are a year into the pandemic. Over time, students and faculty may be more receptive to online learning and confidence might improve throughout the course of the COVID-19 pandemic. Further research examining the perceptions of students and faculty after adapting to this new learning environment should be pursued. The main advantage to online learning is that it provides flexibility, accessibility, less money spent, ability for students to learn independently, and a less intimidating learning environment. However, students may have different learning styles and feel more engaged with live virtual classes vs. pre-recorded lectures.[14] Studies have confirmed that adult-learning styles can change over time; it would be interesting to see if learning styles change over time during the pandemic.[14]

In conclusion, the COVID-19 pandemic has changed how we socialize and provide medical education. Medical school faculty and students were not prepared for the challenges of remote learning. This has left medical students with the perception of having received inadequate or low-quality education. Medical schools must continue to create a curriculum that engages students in order to improve the quality of their learning experience as well as to improve the sequelae of social isolation during this pandemic.



 
  References Top

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Koohestani HR, Baghcheghi N A comparison of learning styles of undergraduate health-care professional students at the beginning, middle, and end of the educational course over a 4-year study period (2015–2018). J Educ Health Promot 2020;9:208.  Back to cited text no. 14
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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