Marcelus 1

Renel Marcelus Jr:

Dr. Guenzel
ENC 1102-0M37
4/5/2021

Covid-19’s Effects on Medical Students’ Training

Ever since the Covid-19 pandemic started in early 2020, the whole world has been

dealing with a multitude of new problems. One of the main problems was the closure of

businesses and schools. Although these places were closed for our safety, they have affected the

flow of things in the economy and our daily lives. People are out of work and students must be

educated online. The transition to online education can be rough for many students, especially

for college/graduate students who either need hands-on experience for their major or just learn

better through in-person instruction. What this paper discusses is whether these changes can

potentially be detrimental to a student’s success in school, specifically pre-med and medical

students as they are known for requiring hands-on/work experience before fully delving into

their career in the medical field. As stated in a STAT News article, “clinical students [who are]

in their third and fourth years of medical school, work in hospitals” (Farber). So because many of

these students work in hospitals, many or all of them would have to be sent back home to keep

them safe due to Covid-19 patients mainly residing in hospitals. This helps to shed some light on

the position that pre-med/medical students are in, as some or many of them may be restricted in

this exact way. Their education moving to online learning can also cause problems, as what

they’re being taught may require some in-person/hands-on instructions. The three things that will

be analyzed to determine if the effects of Covid-19 are negative towards pre-med/medical

students are their online education, hands-on/work experience, and their psychological impact

that may affect their performance on these tasks.

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Online Learning:

The transition to online learning has been concerning to many people who fear a diminish

in the quality of school education, which could potentially make it more difficult for students to

understand or get the full scope of a subject. One can see how this can be especially concerning

for medical students. In a PLOS ONE article, a group of authors in Libya, Alfousi et al., worked

together to create a survey for Libyan medical students that asked many things, including “their

experience with medical tele-education”. They were able to “[collect] 3,348 complete

questionnaires completed by medical students from more than 13 medical schools in Libya”; and

based on their results from the statistics they did for a question asking their participants to rank

their understanding of online learning on a scale from 0 to 6, they found out that 75.7% of their

participants “had a poor understanding of e-learning” (Alsoufi). This data gives insight into how

medical students can potentially perform negatively due to being educated online. However, this

is just data collected from one country. To make the general assumption of online education

being a negative thing for health students, other colleges, universities, and countries must be

observed. Another article posted on NCBI shows similar results as Libya for “a survey [that] was

distributed to first- and second-year medical students at the University of California San Diego

School of Medicine in March 2020” (Shahrvini). Within the survey, 53.7% of those students

(out of 268) responded that they “felt [as though] remote learning had negatively affected the

quality of instruction and their ability to participate” (Shahrvini). A more detailed look into how

pre-med and medical students’ education are affected is through an article by the GMS Journal

for Medical Education which talks about Covid-19 forcing auscultation training to move online.

Auscultation is a basic medical procedure/technique that’s learned in medical school “through

supervised examination of patients often supported by simulator-based learning” (Rüllmann).

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Medical training, such as this, moving online can be a problem if the quality of the course is

subpar.

However, in the survey for this article, participants of the online auscultation training had

“high level[s] of satisfaction” with the course and “assessed [that] their recognition of

auscultation findings after completion of the course [to be] good”; they also recommended to put

the course in the regular curriculum (Rüllmann). Another study done by the Division of

Narrative Medicine at Columbia University, published by MedEdPublish, had similar results of

successful online education for their narrative medicine workshops. Narrative medicine

workshops are things where participants (pre-med or medical students) “read a text to spark

discussion around personal wellbeing or ethical questions in medicine[; they] then participate in

a writing exercise and share their responses [with one another] (Winkel, 2016)” (Iwai). These

types of discussions would usually fare better in person because people would be more likely to

engage in the conversation. But according to the authors of the article, they stated that the

“participants [of these workshops] … appreciated [it] and enjoyed participating despite the

online setting” (Iwai). So, what can be observed from the participants’ responses, in both articles,

is that Covid-19 can also create positive impacts on pre-med and medical students learning by

allowing schools to have the opportunity to explore online education that can potentially improve

their students training and education if done properly.

Impact on Clinical Experience:

Clinical experience as a pre-med or medical student is an important prerequisite that will

help these students when they transition into their actual jobs. In the hospital scene, “medical

students generally operate on a spectrum between shadowers and providers” for many many
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things such as operation (Farber). So, students being forced out of these work areas for their

safety, due to the Covid-19 virus, can potentially cause harm for their transition into their future

occupations. An article, published by BMC Medical Education, explores this study with a report

of students’ perception of “pre-graduation medical training including virtual reality during [the]

Covid-19 pandemic” (De Ponti). As stated in this article, the “School of Medicine [at the] the

University of Insubria [in Varese, Italy]” had a course called “Medicine and Surgery” where

medical students would go to hospitals receive medical training on surgeries and medicine; but

because of Covid-19, everything was moved to virtual reality where students were “allow[ed] to

enter different simulated clinical scenarios… perform physical examination[s], call for

laboratory and imaging tests, [etc.]” (De Ponti). Medical students’ responses to the virtual course

were surprisingly positive; about 55% of the 115 medical students who did the questionnaires

“preferred [their] online training with [the] Body Interact [website]” (De Ponti). In an article

published by the Journal of Surgical Education, the authors talk about similar circumstances

moving training online. For this article specifically, it was the idea of “live-streaming surger[ies]

for medical student[s] ” (Jack). The authors, who are medical doctors, stated that “live-streaming

surgery provided a method to achieve active learning for students and residents as opposed to

passive learning such as watching a previously recorded video or listening to a lecture on

surgical approaches''; the surgeons also stated that they felt as though there was more

engagement from the medical students than if they were to be physically standing in the

operating room (Jack). There were some problems with streaming the surgeries, such as the

camera not being able to show the full scope of the “surgical field in detail”, the overall feedback

of live-streaming surgeries was positive for the medical doctors. From the observations made in
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these articles about receiving clinical experience online during the pandemic, there seems to be a

positive trend in this area.

However, there are those who advocate for medical students to return to the medical

field, such as Orly Nadell Farber, who wrote an article on STAT to persuade people to not send

medical students home. She argues that medical students can help out during Covid-19 by

“contribut[ing] to patient care by coordinating medications and procedures, consulting with

nurses and specialists, and updating patients and their families on the care plan [on a busy

internal medical service]” (Farber). She also says that there could be “long-term consequences”

for taking medical students out of hospitals, as “[t]here’s no online substitute for learning direct

patient care” (Farber). However, these claims made by Farber were early on in 2020 when the

lockdown for Covid-19 was just starting in the United States of America, way before online

education was implemented properly. As seen by the previous articles about moving medical

training/clinical experience online, the virtual learning experience seems to have positive

reactions from the medical students involved. As for bringing medical students back into

hospitals, it is questionable if the benefits outweigh the costs as they are being put into danger by

receiving training within the hospitals. Medical students are needed for the future labor force of

medical occupations, it’s probably best to keep them safe by not putting them in direct contact

with the Covid-19 virus.

Mental Health:

The mental health status of pre-med and medical students has the possibility of

drastically changing due to their education and training moving online as a direct result of

Covid-19. If things like anxiety levels and depression rates of pre-med and medical students
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increase, then it can potentially cause a decrease in performance for their education and clinical

experience. Such things should be monitored to make sure that this doesn’t happen. In the article

discussed earlier that surveyed medical students across 13 different medical schools in Libya,

“high level[s] of anxiety and depression [were] found among medical students, of whom 31.3%

exhibited a high likelihood of experiencing depressive symptoms” (Alsoufi). In one of their

graphs, which displays medical students’ “attitudes towards Covid-19” by answering “strongly

disagree, disagree, neutral, agree, or strongly agree”, 40.2% of students (majority) agreed that

“Covid-19 affected [their] mental well-being and overall health”; 35.1% (majority) also agreed

that “Covid-19 affected [their] intellectual wellbeing and ability to learn” (Alsoufi). These

statistics for the Libyan medical students help to give proof that Covid-19 can harm medical

students’ mental health. To observe if medical students in other countries are having

deterioration in mental health due to Covid-19, an article published by the Pakistan Journal of

Medical Sciences will observe this exact problem within Turkey. However, this article talks

more specifically about medical students “worr[ying] about being infected with Covid-19”, not

with education in particular; but it is still worth noting this (Torun). “The total number of

participants [for the study] was 275 students” and many of the “medical students were highly

worried about being infected with COVID-19” (Torun). As observed in the previous article in

Libya, students worrying about Covid-19, in general, can have higher levels of anxiety; so the

same idea of students in Turkey having higher levels of anxiety can be inferred. In the article

published by BMC Medical Education, “Most second-year students (56.7%) [, at the University

of California San Diego School of Medicine,] felt their preparation for the United States Medical

Licensing Examination Step 1 exam was negatively affected, and 43.3% felt unprepared to begin

clerkships.” (Shahrvini). These medical students “at the University of California San Diego
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School of Medicine in March 2020” are feeling as if their education was insufficient to allow

them to pass the exams to become licensed. This type of mindset can increase the anxiety levels

of these medical students.

1
Firgure of medical students’ responses to how Covid-19 affected them in the listed ways

(Alsoufi).

1 Chart displaying 3,348 medical students’ responses to how Covid-19 affected them in the ways
the specified ways. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242905
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Discussion:

After examining several research studies according to online learning, clinical experience

and mental health, I concluded that online education and training for pre-med and medical

students during the pandemic is overall successful in many places throughout the world,

however, the effort has to be put in to make sure that these online classes are successful. If no

effort is put in to make quality classes and training, students are more likely to have lower

performances which must not happen. As for pre-med and medical students’ mental health,

Covid-19 has seemed to have caused anxiety levels to increase for many people, and increased

anxiety levels can potentially lower the students’ performances. So, it is pertinent that classes

and training for pre-med and medical students need to be structured in a way that doesn’t cause a

decrease in their mental health.

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Works Cited:
Alsoufi, Ahmed, et al. “Impact of the COVID-19 Pandemic on Medical Education:
Medical Students' Knowledge, Attitudes, and Practices Regarding Electronic
Learning.” PLOS ONE, Public Library of Science,
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242905
Baecher-Lind, Laura, et al. “Medical Education and Safety as Co-Priorities in the... :
Obstetrics & Gynecology.” LWW,
https://journals.lww.com/greenjournal/Fulltext/2020/10000/Medical_Education_a
nd_Safety_as_Co_priorities_in.28.aspx
De Ponti, Roberto, et al. “Pre-Graduation Medical Training Including Virtual Reality
during COVID-19 Pandemic: a Report on Students' Perception.” BMC Medical
Education, U.S. National Library of Medicine,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517753/.
Dhillon, Jobanpreet, et al. “Impact of COVID-19 on Canadian Medical Education: Pre-
Clerkship and Clerkship Students Affected Differently.” Journal of Medical
Education and Curricular Development, U.S. National Library of Medicine,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576927/.
Dowd, Brianna, et al. “The Impact of COVID-19 Pandemic on Medical School
Admissions: Challenges and Solutions.” The Journal of Surgical Research,
Elsevier Inc., Feb. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC7492063/.
Farber, Orly Nadell. “Medical Students Can Help Combat Covid-19. Don't Send Them
Home.” STAT, 16 Mar. 2020, www.statnews.com/2020/03/14/medical-students-
can-help-combat-covid-19/.
Gaur, Uma, et al. “Challenges and Opportunities of Preclinical Medical Education:
COVID-19 Crisis and Beyond.” SN Comprehensive Clinical Medicine, Springer
International Publishing, 22 Sept. 2020,
www.ncbi.nlm.nih.gov/pmc/articles/PMC7508422/.
Gupta, Subhangi, et al. “Medical Education during COVID-19 Associated Lockdown:
Faculty and Students' Perspective.” Medical Journal Armed Forces India,
Elsevier, 2 Feb. 2021,
www.sciencedirect.com/science/article/pii/S0377123720302689.
Iwai, Yoshiko, and Penelope Lusk. “Transition to Virtual Reflection: Narrative Medicine
during COVID-19.” MedEdPublish, www.mededpublish.org/Manuscripts/3171.
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Jack, Megan M, et al. “Live-Streaming Surgery for Medical Student Education -

Educational Solutions in Neurosurgery During the COVID-19 Pandemic.” Journal
of Surgical Education, U.S. National Library of Medicine,
https://www.sciencedirect.com/science/article/pii/S1931720420302397?via
%3Dihub.
Murphy, Brendan. “With Volunteering Limited, Med Schools Adjust Admissions
Expectations.” American Medical Association, 8 July 2020, www.ama-
assn.org/residents-students/preparing-medical-school/volunteering-limited-med-
schools-adjust-admissions.
Rüllmann, Nils, et al. “Virtual Auscultation Course for Medical Students via Video Chat
in Times of COVID-19.” GMS Journal for Medical Education, U.S. National
Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7740006/.
Sandhaus, Yoram, et al. “Electronic Distance Learning of Pre-Clinical Studies During the
COVID-19 Pandemic: A Preliminary Study of Medical Student Responses and
Potential Future Impact.” The Israel Medical Association Journal: IMAJ, U.S.
National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/33236581/.
Shahrvini, Bita, et al. “Pre-Clinical Remote Undergraduate Medical Education during the
COVID-19 Pandemic: a Survey Study.” BMC Medical Education, U.S. National
Library of Medicine, www.ncbi.nlm.nih.gov/pmc/articles/PMC7786143/.
Torun, Fuat, and Torun, Sebahat Dilek. “The Psychological Impact of the COVID-19
Pandemic on Medical Students in Turkey.” Pakistan Journal of Medical Sciences,
U.S. National Library of Medicine,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501012/.