Updated: Apr 10, 2021
The route to successfully obtaining a comprehensive medical education, although challenging, is relatively straightforward and predictable, this involves demonstrating apt knowledge of medicine through written and practical assessments, gaining and developing clinical and social competencies by shadowing health professionals and participation in clinical and non-clinical activities. However, since early 2020 medical training for our future doctors has been severely impacted and disrupted by the COVID-19 pandemic. Most notably, the dissolution of thousands of hours of clinical training, disruption of teaching, as well as the cancellation and/ or postponement of exams (Rainbow and Dorji, 2020). In July 2020, an article published in The Lancet described how several UK teaching hospitals are
“suspending medical and observership students from attending clinical attachments”
to contain the spread of COVID-19 (Ahmed, Allaf and Elghazaly, 2021), this number has increased since. Online learning became the primary response to continue facilitating medical education during this crisis, but has it been enough?
A national cross-sectional survey conducted in 2020 looked at medical students’ perceptions of online learning. The perceived benefits of online learning according to the study included flexibility, reduction of travel costs, ease of access to lecture recordings, live lectures and teachers via the internet- students have become more self-directed learners and can digest information in their own time. Nonetheless, there are also major setbacks to online learning, the study showed that major perceived barriers included family distraction (26.7%) and poor internet connection (21.53%) (Dost et al., 2020). Another study highlighted that unemployment of family members, caring responsibilities, increased levels of stress due to long periods of self-isolation and inequality in access to remote learning platforms also disadvantaged students (Sharma and Bhaskar, 2020). Therefore, those from more vulnerable and/or underprivileged backgrounds are likely to face more environmental stressors that might impact their learning and assessment outcomes.
Under normal circumstances, medical students were already an at-risk group for increased rates of anxiety and burnout. Globally, approximately 1 in 3 medical students have anxiety, which is significantly higher than the global prevalence rate (Quek et al., 2019). A study conducted in the US showed at least half of all medical students are impacted by burnout, which is associated with suicidal ideations and psychiatric disorders (Ishak et al., 2013). More recent studies have also shown declined mental wellbeing of medical students during the pandemic, and how this has significant implications in study behaviours, and consequently their academic performance. One study highlighted students feeling emo
tionally detached from family, friends and a decrease in their overall work performance and study period (Meo et al., 2020). Another study showed that there has been a significant increase in depression, anxiety and stress during the COVID19 pandemic (Saraswathi et al., 2020). An opinion piece written by medical student Leah Komer highlights the pressures faced by medical students and the importance of appropriate support for students; explaining that
"with the demands and pressures that medical students face, it is no surprise that our mental, physical and spiritual wellbeing can be compromised. Ironically, a field that advocates the promotion of health and wellness in patients falls behind in supporting and addressing the needs of its students" (Komer, 2020)
Although all university students will face the same pressures in terms of not having face-to-face learning, medical students are unique in their struggle and are particularly more impacted by the necessary lockdown regulation and the social distancing measures. A core component of medical training is the inherent practical aspect of seeing and speaking to patients face to face, taking histories, practising and conducting different physical examinations with peers/patients and getting a real understanding of the clinical environment to gain relevant competencies.
Understandably, these skills cannot be gained traditionally during the pandemic, postponement in gaining these skills but continuous progression through the degree doesn’t solve the issue either. One study highlights the complexity of providing a medical education, and how the integration of theoretical sessions alongside clinical training and exposure is key in preparing the next generation of doctors to meet the high standards of care and professionalism: a key aspect of professionalism being clinical excellence.
Although remote learning has been a fantastic way of facilitating students to continue studying and staying in contact with peers and professors it is far from ideal, as it is unable to substitute necessary soft skills such as patient communication, professionalism and other interpersonal skills.
The COVID19 pandemic is no doubt impacting everyone in varying degrees. Social isolation, death of loved ones, unemployment and consequences of lockdown on the economy will have long term implications even after the pandemic. Medical students will also face these same implications in addition to achieving a high standard of medical training to equip them with the necessary skills to interact with the public. Therefore, universities and governments need to take appropriate measures and work with students to mitigate these consequences. This includes universities taking the initiative to promote mental health wellbeing, reaching out to students who may be struggling, improving access to counselling, financial aid, re-structuring medical curriculum and designing an effective remote learning programme to educate our future doctors even if it may take some time.
Contact the author: @silsilam
Disclaimer: the views, thoughts, and opinions expressed in the text belong solely to the author and do not necessarily reflect the official policy or position of Identity International.
Ahmed, H., Allaf, M. and Elghazaly, H., 2021. COVID-19 and medical education.
Dost, S., Hossain, A., Shehab, M., Abdelwahed, A. and Al-Nusair, L., 2020. Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students. BMJ Open, 10(11), p.e042378.
Ishak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D. and Bernstein, C., 2013. Burnout in medical students: a systematic review. The Clinical Teacher, 10(4), pp.242-245.
Jodheea-Jutton, A., 2021. Reflection on the effect of COVID-19 on medical education as we hit a second wave. [online] MedEdPublish. Available at: <https://www.mededpublish.org/manuscripts/3563> [Accessed 28 March 2021].
Komer, L., 2020. COVID-19 amongst the Pandemic of Medical Student Mental Health. International Journal of Medical Students, 8(1), pp.56-57.
Meo, S., Abukhalaf, D., Alomar, A., Sattar, K. and Klonoff, D., 2020. COVID-19 Pandemic: Impact of Quarantine on Medical Students’ Mental Wellbeing and Learning Behaviors. Pakistan Journal of Medical Sciences, 36(COVID19-S4).
Quek, Tam, Tran, Zhang, Zhang, Ho and Ho, 2019. The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. International Journal of Environmental Research and Public Health, 16(15), p.2735.
Rainbow, S. and Dorji, T., 2020. Impact of COVID-19 on medical students in the United Kingdom. Germs, 10(3), pp.240-243.
Saraswathi, I., Saikarthik, J., Senthil Kumar, K., Madhan Srinivasan, K., Ardhanaari, M. and Gunapriya, R., 2020. Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: a prospective longitudinal study. PeerJ, 8, p.e10164.
Sharma, D. and Bhaskar, S., 2020. Addressing the Covid-19 Burden on Medical Education and Training: The Role of Telemedicine and Tele-Education During and Beyond the Pandemic. Frontiers in Public Health, 8.