med school covid essay

How to Discuss Coronavirus in Med School Essays

The key to addressing COVID-19 in medical school applications is an organized approach.

COVID-19 and Med School Essays

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Applicants may consider reflecting on current circumstances in a personal statement.

With changes taking place in virtually all industries across the U.S. as a result of the coronavirus pandemic, medical schools and applicants are also bracing themselves for the impact of this disease outbreak on the admissions process. Many students are anxious and concerned about the repercussions of school closures on their ability to put in a timely and strong application to medical school.

If you are among those applicants whose plans have been altered by recent events, you are not alone. Medical schools are aware that applicants have had to make adjustments to their plans, including taking courses online or postponing their MCAT test date.

If you have experienced changes to your education as a result of the spread of COVID-19, the disease caused by the novel coronavirus , your primary and secondary applications can serve as an opportunity for you to share these changes with medical schools.

In fact, AACOMAS , the American Association of Colleges of Osteopathic Medicine Application Service, specifically asks applicants to address how the pandemic has affected their plans. Some secondary applications also ask applicants to describe any events that have affected their education. You may even consider using your personal statement to reflect on current circumstances.

When writing about COVID-19 in your medical school application, it's important to stay organized. Consider covering one or more of the following areas as they relate to you:

• Clinical and research experiences.
• Outlook on medicine.

If you were enrolled in college classes this spring, chances are your coursework was moved online. Some schools have also changed grading systems, allowing students to opt for a pass-fail grade.

If these changes apply to you, consider how they affected your academics and share the impact with the medical school admissions committee. If you decided to continue taking classes for a letter grade despite having the option of choosing pass-fail, you could let schools know. This shows that you were motivated to work hard and excel despite the challenges you had to face.

You can also write about how changes in coursework have affected your applications to medical school. For example, some students report that it has been harder to ask professors for letters of recommendation . In the absence of in-person office hours, lectures, seminars and labs, they find that it is more difficult for professors to get to know them substantially and write strong letters. If this is the case with you, it may be worth explaining in your application.

If you are among the pool of medical school applicants whose MCAT has been postponed because of testing site closures, you can use the application to inform the admissions committee of this change. If you were intending to take the MCAT in April but have to wait until July, let the medical schools know that your original plan was to take the test early.

Clinical and Research Experiences

Many students have had to cut short clinical volunteer work. Others have had to halt their research in laboratory or hospital settings. It is good to explain such changes in your application. When doing so, provide details.

For example, if you had been volunteering at a hospital for five hours a week for the last nine months and were slated to continue that work in April and May, calculate the number of hours you would have accumulated in those two months and indicate to the admissions committee how many fewer hours you will have as a result of changes.

Similarly, if you were involved in a research project that was close to producing some results or if you were planning on presenting your research at a seminar or conference, it is worth letting the committee know how such plans were affected.

Outlook on Medicine

In addition to the above, it may be worth reflecting on how this pandemic has affected your outlook on life, your career and the medical profession. By thinking about these issues and sharing your reflections in your medical school application, you can help the admissions committee get a better sense of who you are.

For some, this may be a very personal experience. One of our students wrote in her essay about losing her grandfather to COVID-19. She went on to explain that her grandfather always valued a higher education and described how his loss further motivated her to pursue a medical education to keep his legacy alive.

Even if you have not had the direct experience of losing a loved one to COVID-19, or have not had someone close to you fall ill to this condition, you can share your outlook. For example, has the pandemic influenced your view on the roles and responsibilities of health care providers? What have you learned about the disparities in health care as you examine the current situation we face? How has your motivation for medicine increased because of the stories of loss and pain that we hear about every day in the news?

As you reflect on these questions, consider reading reliable news outlets for analysis on the various issues relating to this global public health problem. For example, one student shared in her medical school application that in witnessing COVID-19's disproportionate impact on minority populations , she has become more motivated to work with these populations as a future physician.

Keep in mind that while COVID-19 may have had an important impact on you, it should not constitute the entirety of your essay or application. How much you write about it and exactly where you share the information will depend on your application. You may devote a paragraph to it in your personal statement, use space allotted specifically to this question in the primary application such as AACOMAS or mention it in your secondary applications where relevant.

However, as you describe how the pandemic has affected you, do not neglect to mention the many other ways in which you have prepared for medical school before this unforeseen event.

Medical School Application Mistakes

Tags: medical school , graduate schools , Coronavirus , education , students

About Medical School Admissions Doctor

Need a guide through the murky medical school admissions process? Medical School Admissions Doctor offers a roundup of expert and student voices in the field to guide prospective students in their pursuit of a medical education. The blog is currently authored by Dr. Ali Loftizadeh, Dr. Azadeh Salek and Zach Grimmett at Admissions Helpers , a provider of medical school application services; Dr. Renee Marinelli at MedSchoolCoach , a premed and med school admissions consultancy; Dr. Rachel Rizal, co-founder and CEO of the Cracking Med School Admissions consultancy; Dr. Cassie Kosarec at Varsity Tutors , an advertiser with U.S. News & World Report; Dr. Kathleen Franco, a med school emeritus professor and psychiatrist; and Liana Meffert, a fourth-year medical student at the University of Iowa's Carver College of Medicine and a writer for Admissions Helpers. Got a question? Email [email protected] .

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How to Write About COVID-19 in Your Medical School Personal Statement

Don’t Make Your Personal Statement All About COVID

COVID-centered personal statements are sure to inundate current and future admissions cycles. The pandemic has indelibly altered public health, virology studies, the forms and pace of medical education as well as life in general.

Since your medical school admissions readers are likely also physicians treating COVID-19 patients and guiding the community toward best practices for reducing transmission, there’s not a lot they haven’t already heard about the virus. They likely teach on campuses that suspended instruction or shifted it online last year and are well aware your MCATs were canceled or moved. They may even know first-hand how much more help is needed around the house back home, including consoling folks who are afraid of the vaccine for a variety of reasons.

That’s why it’s all the more important for your medical school essay to illustrate a life that centers on you.

Show Instead of Tell to Illustrate Your Story Personally

The applicant’s life should be the main idea of the personal statement, even though COVID can play the role of literary foil. COVID is an unfortunate part of your daily life, but you can still keep your personal statement about yourself, not the pandemic. This way, you allow your reader to feel the aggravation and doom of these moments while enabling you to emerge as the story’s main character. Don’t just “tell” your story. “Show” your story. See what I mean.

Telling – “COVID disrupted my MCAT.” 

Note: Can you write about this in a more personal way? 

Revised to Showing : “My phone vibrated with a notification that the MCAT was canceled. And here’s what I did to overcome that obstacle.”

Telling – “Among the public are vaccination skeptics.”

Note: Who from the public have you talked to and what was the history and context of their medical fear? 

Revised to Showing – “Grammy and I had a looooong conversation about her grandmother’s flu from the 1918 pandemic .”  Then compare and contrast the public’s reaction between then and now, and the importance of vaccinations.

Telling – “I’ve been taking care of my little brother and my father.”

Note: What was asked of you? How did you respond?

Revised to Showing – “From his basement lair, my dad hollered, ‘Test tomorrow! Place Values and Number Sense!’ I searched upstairs for my little brother who was hiding from Math under all the laundry. My dad’s in quarantine, the dairy’s in the snow. And Paris in springtime means I’m Mom now while blackouts are rolling through Texas.”

When you show the core competencies suggested by AAMC , you create a picture for your reader to visualize how you could be an excellent physician in a way that makes your personality shine through.

You: Resilient and adaptable at a push notification’s notice.

You: E thical and moral with the vulnerable.

You: Taking on extra responsibility. COVID is still prevalent, just decentered because yours is a story about teamwork. 

Set COVID-19 as the Supporting Character in Your Personal Statement 

Set the scene with the pandemic details that help you tell your story.

If your narrative anecdote is about ice hockey team practice, let it be that. Surely there are NHL COVID protocols the team has made and adjustments to uphold, whether it’s “minimize handshakes, high fives and fist bumps” or (courtesy of Highly Questionable on ESPN) “don’t lick opponents in the face.”

These are the details that should provide context and are important for illustrating life distinctly to ensure you haven’t stated the obvious or something that other applicants have already covered. Since it’s about you, personally. 

Another way to include COVID in your story is to consider how it relates to your work in STEM. For instance, Scientific American rendered COVID in 3D . Maybe you have similar accomplishments you’d like to showcase. In your personal statement, include some of the technical details of the project but focus on what it was like to work with your lab partners and perhaps highlight your own sense of reliability and dependability. 

A whopping topic like COVID-19 has the capacity to overshadow even the best pre-med if allowed to dominate an essay.

Customary topics and redundant statements will undercut what the Personal Comments Essay is designed by AAMC for you to be able to do. See their Application Guide to see how you can distinguish yourself from other applicants .

Make your essay all about you and write the daily life details that make your story personal. That will get you accepted, and hopefully, we can put the pandemic behind us.

If you’re still feeling stuck on your personal statement or want expert feedback on an existing personal statement, check out MedSchoolCoach. With MedSchoolCoach, you get the benefit of working with a professional writing advisor to help you develop your essays into a great application. 98% of students who used MedSchoolCoach last year to develop their personal statement received at least 1 interview invite.

Related posts:

• Everything You Need To Know About the AAMC PREview Exam
• 5 Ways to Document Your Pre-Med Experiences
• Can International Students Apply to U.S. Medical Schools?
• Introduction to Ontario Medical School Application Requirements

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Impact of COVID-19 on Medical Education: Perspectives From Students

Marie walters , phd, mphil, md, taiwo alonge , md, mph, matthew zeller , do.

• Author information
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Correspondence should be addressed to Matthew Zeller, 404 Evesham Ave., Baltimore, MD 21212; telephone (503) 998-1427; email: [email protected] .

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Issue date 2022 Mar.

This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

This article provides an overview of issues facing medical students in such key areas as communication, preclinical and clinical education, increased isolation, disruption to time-based curricula, inequities in virtual learning, racial trauma, medical student activism, increased conversations surrounding race and racism, LGBTQIA+ students, dual-degree students, and the virtual residency cycle. This article described challenges navigated by medical students during the COVID-19 pandemic, as well as triumphs resulting from the disruption and actionable recommendations in key areas. While the pandemic presented new challenges for medical students, it also uncovered or exacerbated long-standing problems. The intent is for medical schools and institutions to use these recommendations to create learning environments that do not depend on medical student resilience. The main takeaways for medical schools are to: (1) maintain an individualized and learner-centered ethos while remaining dynamic, flexible, and ready to embrace both immediate and incremental changes; (2) maintain open lines of communication; (3) implement policies and practices that support students’ academic, physical, and mental well-being; (4) engage and support students who bear historically disadvantaged identities on the basis of race, ethnicity, sexual orientation, gender, or disability; and (5) support creative and collaborative partnerships between medical institutions and students to ensure the ongoing evolution of medical education to meet the needs of learners and patients.

Medical education navigated unique challenges and an unprecedented rate of change in response to the novel coronavirus (COVID-19) pandemic. This article outlines the experience of United States medical students as they traversed the pandemic, a tumultuous sociopolitical climate, numerous devastating natural disasters, and uncharted territory in their education. Although the authors have represented medical students by serving as national leaders and engaging with students across the medical continuum, we by no means reflect the full diversity of student voices and therefore have drawn upon the literature as well as anecdotal conversations with peers and professional colleagues to supplement the arguments and conclusions.

One critical component that we wish to emphasize is the recognition of the inherent resilience and grit of medical students who took authority over their own education and were a large part of, and sometimes the sole innovators of, interventions that preserved medical education during the pandemic. While transforming medical education, students also responded to the nation’s collective trauma by mobilizing as social activists, public health leaders, and critical support volunteers for frontline workers, all while taking care of their own families and communities.

This paper provides an overview of issues facing medical students in such key areas as communication, preclinical and clinical education, increased isolation, disruption to time-based curricula, inequities in virtual learning, racial trauma, medical student activism, increased conversations surrounding race and racism, LGBTQIA+ students, dual-degree students, and the virtual residency cycle. The sections illuminate students’ perspectives on how COVID-19 impacted medical education, delineate the continued challenges facing medical education, and provide specific recommendations to leverage lessons learned.

Issues Facing Medical Students

Communication.

The rapidly changing COVID-19 landscape highlighted the need for timely, transparent, and accurate communication. The pandemic also intensified sociopolitical conflicts, which impacted students’ well-being and ability to perform academically. To help understand the implications of COVID-19 and sociopolitical events on medical education (see Figure 1 ), students looked to their institution’s administrators for guidance and frequent communication more than ever before, some requesting town halls as a forum to transparently discuss immediate concerns. The authors’ home institutions increased their frequency of town hall meetings to weekly or biweekly, sent daily listserv notifications, and increased their social media activity.

Timeline of educational, sociopolitical, and ecological events integral to understanding the medical student experience in the 2020–2021 academic year, including COVID-19 deaths within the United States. Source: Johns Hopkins University of Medicine. COVID-19 United States Cases. https://coronavirus.jhu.edu/us-map . Abbreviations: USMLE, United States Medical Licensing Examination; CS, Clinical Skills examination; COMLEX, Comprehensive Osteopathic Medical Licensing Examination; PE, Performance Evaluation; VSAS, Visiting Student Application Service; AAMC, Association of American Medical Colleges; ERAS, Electronic Residency Application Service.

Recommendations for effective communication

The power of timely, empathetic statements followed by regular, transparent communication from university leadership alongside student representatives regarding an event impacting students should never be underestimated. The principles espoused by the Centers for Disease Control and Prevention’s (CDC’s) Crisis Emergency Risk Communication program (time-sensitivity, accuracy, honesty, empathy, active orientation approach, and respectfulness) 1 enabled schools to improve university–student communication and should be used for future health, social, and political crises. Another effective communication strategy was utilization of medical student government leaders as intermediaries, which helped streamline communications relevant to specific cohorts. 2 Anecdotally, generalized communication from university presidents or administrators directed to an entire student body was less helpful, as students expressed a disconnect between updates necessary for undergraduates and those specific for each medical school class. Therefore, we recommend partnering with medical student leaders, having frequent and regular town halls, and communicating using the CDC’s Crisis Emergency Risk Communication guidelines when communicating during future crises.

Preclinical education

Before the pandemic, some schools required daily in-person activities, making it difficult to tailor education to an individual’s needs or to take time off for illness, outside commitments, or life events. Virtual learning provided some immediate improvements to medical education, including the ability to access educational materials at students’ convenience 3 and increased flexibility. However, working from home full-time blurred the boundaries between work and life, 4 resulting in students working through illness or personal issues, such as caregiving for a loved one. Furthermore, increased use of online curricula 5 challenged the instruction and assessment of clinical medicine skills including physical exam, patient encounters, and laboratory dissections.

The importance of establishing peer and professional relationships was emphasized when opportunities for networking, research, and professional development diminished during exclusively virtual premedical education. In conversations and online forums, students wondered if their education sufficiently prepared them for rotations. Given the perceived decrease in educational quality and lack of physical access to university resources, students also questioned tuition prices. The cost of a completely virtual medical education has become less relevant now that schools have reopened. However, we feel that tuition and medical education debt remain critical topics that require ongoing examination.

Recommendations for preclinical education

We recommend that, postpandemic, medical education maintain both flexibility and accessibility to educational resources by continuing to record all learning activities so that students can access them 24/7. Other recommendations include working to obtain discounted proprietary study materials and removing attendance requirements that limited access to PowerPoint presentations or lectures. Learning communities such as the House Advisory Systems have proven effective at forming support communities and bolstering networking in a wholly virtual space. 6 , 7

Increased isolation and need for support services

The long-term impacts of educational changes faced by preclinical students have yet to be determined, but preliminary surveys show preclinical students were significantly more likely to report higher symptoms of burnout during the pandemic. 5 , 8 Students from marginalized communities hit hardest by COVID-19 were sometimes unable to attend funerals or care for sick relatives due to travel restrictions. Students were not immune to the trauma and hardships the rest of the world was experiencing, and many students continued to support their families despite their medical school workloads.

Although the need for mental health and support services was higher than ever, students were physically isolated and had decreased access to support. 3 Students beginning medical school in fall 2020 never met their entire class in-person or oriented to their new locations because mass gatherings were prohibited and businesses were closed. Without being able to visit support communities back home, students’ lack of peer interaction and inability to develop or sustain local support systems was exceptionally detrimental. Mental health services were more difficult to access due to counseling centers exceeding their capacities. With universities physically closed, opportunities to destress at the gym or interface with support services, such as student affairs offices and offices of diversity and inclusion, were limited or eliminated entirely.

Recommendations to address increased isolation and need for support services

One of the most urgent recommendations is to decrease the extent of isolation preclinical students are facing, formally check on students’ mental health, and increase access to mental health and support resources. Since this report was first drafted, in-person learning has resumed. However, should the need to go entirely virtual occur again, virtual group clinical opportunities and study sessions 9 are recommended, as they reduced isolation and provided opportunities for meaningful interaction with peers.

Clinical education

When clinical rotations were abruptly paused in March of 2020, virtual clinical experiences emerged, including virtual rotations, 5 , 10 virtual rounds, 10 and telehealth rotations. 11 In virtual rounds of the medical intensive care unit, students engaged with physicians and patients with COVID-19 via live chat, gaining unique insight into clinical care. Ninety percent of students polled found this method of learning to be engaging, meaningful, and informative, with one student commenting that virtual rounds “helped remind all of us why we chose to pursue a path in medicine.” 10 While universities were pushed to explore new ways for students to achieve high-quality education, medical students were innovating too. Students organized COVID-19 student response teams, which led to the development of a comprehensive COVID-19 curriculum that has reached over 80,000 learners worldwide. 12 Similarly, one author’s (M.Z.) personal experience of increased flexibility with clinical rotations allowed him to partner with medical education streaming service GIBLIB and 20 other medical students to create free, video-based surgical education for students on clinical rotations. 13 Students involved in these activities met their community’s needs while demonstrating agency, lifelong learning, and creative problem-solving.

In addition to augmenting their own education, students found creative ways to use the skill sets they possessed to improve well-being in their communities. Students joined their institutions’ COVID-19 task forces or assembled task force teams themselves to support frontline workers, health systems, or vulnerable patient populations within their communities. 12 , 14 Students with clinical training before medical school joined frontline workers as physician assistants, nurses, or emergency medical technicians. Others delved into research, activism, and education efforts to bolster ongoing public health efforts and mitigate health disparities.

Upon returning to in-person clinical rotations, students encountered reduced volumes and breadth of experience because students were advised to avoid caring for COVID-19 patients and hospitals experienced reduced non–COVID-19 patient volumes. 15 When elective surgeries resumed, many institutions did not return to a similar volume of surgeries, and the number of people allowed in operating rooms was minimized, limiting learner access to surgical experiences. 3

The Coalition of Physician Accountability recommended limiting away rotations 16 at a time when third-year medical students were choosing their specialties and actively applying for visiting rotations, resulting in concerns about decreased exposure to noncore specialties, limited opportunities for letters of recommendation, reduced networking and mentorship, and the inability to experience residency programs of interest. 5 , 17 It was estimated that 1 in 5 students’ specialty choice was affected by the changes brought on by COVID-19, with students most commonly citing lack of exposure to specialties and inability to bolster their applications. 17

Some students questioned if their clinical training was sufficient to prepare them for residency. Fourth-year students going into specialties outside of core-clinical curricula and those at lesser-known or rural schools rely on away rotations to gain exposure to specific patients and clinical experiences. Because away rotations were limited or canceled, 16 some students who had just 1 specialty-specific rotation were concerned about being as prepared for intern year as previous classes who had more.

Recommendations for clinical education

When clinical rotations were interrupted, there was a robust response from the medical education community and medical students themselves to enhance clinical education opportunities. The pandemic illustrated numerous examples of student–faculty collaborations. 2 , 12 Viewing students as cocreators and co-owners of their education empowered them to gain agency and encouraged their creativity, initiative, resilience, and problem-solving skills. 18

Virtual clinical experiences, including virtual audition rotations, were shown to augment medical student education. Maintaining virtual options allows students the flexibility to navigate career exploration as well as barriers in their education, such as family, personal illness, and childcare. We recommend these virtual resources remain available as alternatives or means of augmenting traditional, in-person clinical experiences. We hope the multitude of mentorship opportunities through social media and virtual specialty-specific meetings also continue in the postpandemic era.

Disruption to time-based curricula

Before the pandemic, most medical schools followed rigid time-based curricula without flexible means to accommodate students’ lives outside of school. A prolonged illness or need to attend to family could cause a student to have to take a leave of absence or repeat an entire year. While rigid absence policies always had the potential to adversely affect student well-being, as we diversify medicine, they contribute to inequities in medical education because students who take a leave are less likely to graduate and are more likely to be non-White, racial/ethnic minorities or nontraditional students and/or come from low socioeconomic households. 19 Motivations to maintain the physician pipeline throughout the pandemic meant that schools made more exceptions to absence policies than ever before. For example, at one of the author’s (M.W.) schools, symptomatic or exposed students were allowed to quarantine until a negative COVID-19 test was obtained without the expectation of make-up shifts. The culture of medicine radically shifted from learners being expected to work through illnesses to students signing mandates that they would self-monitor temperatures and stay home when sick.

Other rigid prepandemic absence policies such as “blackout days” where students absolutely cannot request time off and absence limits (e.g., 2 days off during a 4-week rotation) should be reconsidered. While not promoting absenteeism, it is important to contrast missing a few days due to quarantine or illness with the encouraging feedback from 3-year MD programs 20 and students from the class of 2020 who graduated early, 21 which suggest that students can become competent residents with variable time in clinical rotations.

Recommendations to address disruption to time-based curricula

We recommend that medical education maintain the flexibility and focus on self-care that the pandemic mandated. Students should be able to stay home when they or family members are sick or when they have pressing personal issues. Although studies have demonstrated positive correlations between medical school attendance and student performance, 22 more research is needed to discern how strict attendance policies may exacerbate educational inequities by disproportionately harming students who are underrepresented minorities, nontraditional, or who have disabilities. Furthermore, it is critical that students discover their professional limits by making decisions about which events and people take priority. Medical educators can look to 3-year curricular programs, entrustable professional activities, or competency-based education models to devise strategies that limit reliance on time-based curricula.

Life has to be more important than “blackout days,” assessments, or any part of medical education; absence, sick, and vacation policies should reflect that priority by allowing students to make up missed mandatory activities and/or by allowing students to complete competencies in a more individualized manner, as was accomplished during the pandemic. Although medical education is already shifting from time-based to individualized and flexible competency-based curricula, 23 this change will not happen quickly enough to ameliorate the harm of time-based curricula for students who are already disadvantaged due to financial, health, or social factors. Policies should be updated, and increased flexibility should be inaugurated immediately rather than waiting for competency-based curricula to arrive.

Inequities in the virtual learning environment

The pandemic amplified inequities in education. 24 Professional students who were first-generation college students, low-income, or caregivers were significantly more likely to experience increased financial hardships during the pandemic, including loss of income from family members. 24 Students relied heavily on subscription-based resources to supplement their virtual learning, which magnified the academic advantage of financial wealth. Students from low-income backgrounds and students with learning or cognitive disabilities were less likely than their peers to adapt well to virtual education. 25 The virtual environment created additional barriers to learning, such as lack of access to quiet study spaces and reliable technology. 26 Students with disabilities disproportionately reported increased concerns about their physical and mental health and the physical limitations associated with increased computer tasks compared with peers without disabilities. 25 Students beginning medical school with ineffective study strategies, poor self-motivation, or gaps in their basic science knowledge may have had these weaknesses maximized in the home learning environment 27 rather than rectified in an in-person classroom where they could have benefited from engaging with peers who already established these skills or knowledge.

Recommendations to address inequities in virtual learning environments

Because students were differentially affected by the pandemic, it is unlikely that one-size-fits-all solutions will effectively address the issues discussed above. Solutions must be tailored to meet the unique needs of individual learners. Students needing access to campus resources (e.g., reliable internet, quiet environment) should be offered alternative accommodations in the form of stipends or need-based financial aid to cover internet service, computers, or rent. Uniform decisions are more likely to disproportionately harm students who already have educational disadvantages related to social, economic, or demographic factors.

COVID-19’s exacerbation of racialized trauma

Racial disparities in health care, socioeconomics, policing, and so much more were all laid bare and exacerbated by the viral pandemic, 28 – 31 which heightened trauma experienced by students, especially those who identify as Asian American, Native Hawaiian, and Pacific Islander (AANHPI), Black, Brown, and Native American. Disproportionately higher rates of morbidity and mortality from COVID-19 for Black people and other people of color, viral videos of Black people being murdered by the police or anti-Black vigilantes, and heightened anti-Asian racism 28 , 31 , 32 challenged the inherent resiliency of students of color, making performing their medical student duties more arduous than usual. While walking near campus in February 2021, one Asian American medical student was called the “Chinese virus” before being physically assaulted, 33 giving life to fears that many AANHPI and Black students have been carrying. The physical and mental health effects of racial trauma are well documented. 34 , 35 Therefore, many students experienced the deleterious health effects of the double pandemic (structural racism and COVID-19).

Recommendations to address COVID-19’s exacerbation of racialized trauma

Students appreciated humble and genuine acknowledgments from medical school officials about injustices taking place globally, nationally, and within the walls of their medical institutions. We recommend medical school leaders prioritize such action, as it is an appropriate first step in making students feel supported. Furthermore, we recommend acknowledgments that originate from deans’ offices or joint statements be made by medical school leaders rather than solely coming from diversity offices, as is frequently the case. Addressing issues surrounding structural racism is the responsibility of the entire medical school.

Medical schools can provide tangible remedies in the form of listing mental health providers, resources, or offering protected and unencumbered time away when students need a mental health day to process traumatic events or seek care/support. The racialized trauma experienced by students during the pandemic likely will require specific expertise (by way of training or experiential expertise from providers), so we recommend medical schools increase student access to providers of color, providers with expertise in handling racial trauma, or preferably a combination of both. Also, schools can create spaces for students to build community among individuals who share identities. One author’s (T.A.) medical school, at the request of student leaders, created virtual events for Black and Latinx students to meet with Black and Latinx faculty to offer support using an affinity-based format.

Lastly, we recommend that medical schools do their part to disrupt and end racism within their own institutions and beyond. While this is a lofty goal given the centuries of racism at play, all steps to meaningfully dismantle racism move medical schools closer to creating an environment that equitably supports all medical students.

Medical student activism during the pandemic

During the pandemic, increased attention was paid to structural racism by U.S. medical schools, thereby amplifying long-standing medical student activism. Students capitalized on their medical schools’ newfound commitment to stand against racism with hopes of bringing about substantive change, despite processing trauma concurrently themselves. 36 , 37 This effort, amidst a pandemic, came at a greater cost for racially minoritized students, exacerbating the existing burden placed on them and contributing to an increased minority tax. 38

While nonracially minoritized students may have used the unplanned time away from in-person medical student responsibilities to elect to be allies, study for board exams, or engage in extracurricular work to strengthen their CVs, racially minoritized students such as one author (T.A.) used the extra time to partake in necessary and life-affirming activism. One student, a cisgender gay White man, attributed his very high score on United States Medical Licensing Examination Step 2 to having extra months to study when pulled from clinical rotations. For many Black, Brown, and AANHPI students, such an excellent performance was not feasible amidst the stress, anguish, and other deleterious effects of the double pandemic. For this reason, student activism during the pandemic likely furthered the opportunity gap and contributed to decreased wellness for politically and socially engaged students.

Recommendations for supporting medical student activism during the pandemic

We recommend medical schools make genuine commitments backed by tangible action to address the structural racism surfaced and exacerbated by the pandemic. Examples of tangible action include funding to advance diversity, equity, inclusion (DEI) and antiracism efforts; working with expert consultants and/or community members; and changes in or the development of new institutional policies and practices that promote equity for students and within medical education. Moreover, medical schools should do what they can to ensure that their racially minoritized students who engage in these efforts are not engaging to the detriment of their well-being, medical education, or participation in other efforts that could be beneficial to their future careers as physicians.

To ensure sustainability of the DEI efforts made during the pandemic, schools should identify areas where immediate change is possible and areas where incremental change, long-term planning, and strategy are needed. Doing this prevents schools from succumbing to a potentially harmful self-imposed sense of urgency, which may result in efforts falling flat due to the unrealistic expectation of solving centuries of injustices via a short-lived task force or underfunded DEI office. Exemplar schools and residency programs have committed to both short-term and longitudinal, people-centered efforts to integrate equity and antioppressive lenses throughout their curricula, engaging experts and community members in these processes. 39

Students, particularly racially minoritized students, will continue to engage in these efforts as they directly impact their livelihoods. We recommend that medical schools work collaboratively with students, amplifying their efforts and, where appropriate, relieving students of the responsibility of creating equitable change. For students engaging in work that schools will benefit from, we recommend schools look to compensate students for their time, because their efforts go well beyond the role of what a medical student should have to do to become a physician. One author’s (T.A.) medical school created a paid fellowship 40 for students involved in student advocacy and DEI initiatives led by an expert faculty member, who was also given paid, protected time to work with students. These types of efforts create institutional memory, so projects are not lost as students transition through different parts of the medical school curriculum and also address the minority tax experienced by students of color who engage in these efforts.

Increased conversations surrounding racism and race

The social construction that is race is often used as a risk factor for contracting COVID-19 or being at increased risk for morbidity and mortality but without any analysis of the legacy of racism that positioned racialized people as being at greater risk. 39 , 41 , 42 This lack of commentary on race versus racism negatively impacted Black and AANHPI students, whose identities incorrectly became pathognomonic for severe or fatal COVID-19 disease or literally as the disease itself. While the pandemic advanced necessary conversations about racism (as opposed to race) being a social determinant of health, this had direct implications on the experiences of students in classroom and clinical learning environments. Conversations about race and racism in medical schools oftentimes dehumanize racially minoritized students, reducing them to social constructions of race. Furthermore, there is not unanimous agreement or awareness among all physicians, educators, and patients about racism as a social determinant, which leaves racialized medical students subject to further microaggressions and outright racism, dehumanization, and violence.

Recommendations for increased conversations surrounding racism and race

We recommend the creation of strategies that promote accountability and a sense of duty among educators and bystanders to better ensure racially minoritized students are not victims of racism or microaggressions without consequence or support, especially in a sociopolitical climate exacerbated by the COVID-19 pandemic. Bias-free medical curricula with guidelines for educators to use before giving a lecture as well as anonymous reporting systems to monitor and manage bias have been described in the literature. 43 As for racism or microaggressions that occur outside the context of teaching, such as with patients, several bystander tools exist for student or trainee allies and educators to disrupt or otherwise intervene when a situation involves racist language or behaviors. 44 , 45 Lastly, in this work, it is very important to not only understand racism and advocate for the targets of racism (i.e., racially minoritized people) but also seek to dismantle White supremacy as a powerful construct weaponized against racially minoritized individuals. The absence of effective action allows unchecked White supremacy and the continued propagation of structural racism, even in the face of ongoing efforts to advocate for racially minoritized people.

Medical students in LGBTQIA+ communities

Discrimination against those identifying as LGBTQIA+ produces risk factors that increase vulnerability to the pandemic and resultant economic challenges. 46 , 47 The year 2020 saw the highest number of violent murders of people who are transgender or gender nonconforming in recorded history. 48 These additional traumas took energy and focus away from academic endeavors while simultaneously mobilizing some to support and advocate for their community.

When national efforts were employed to develop treatments for COVID-19, a friend of one author (M.W.) remarked, “Maybe if the country had responded this way back in the ’80s, we’d still have the friends and family we lost.” Several memes and articles 49 , 50 highlighting the differential responses to the AIDS versus COVID-19 pandemics revealed painful scars from an earlier pandemic that devastated and stigmatized the LGBTQIA+ community. Unfortunately, our government and health care leadership repeated historical harms by continuing to ignore and minimize calls for help from the LGBTQIA+ community.

One author (M.W.) felt stressful urgency while witnessing members of the LGBTQIA+ community suffer disproportionately from the pandemic but was met with inaction from medical leadership. We cannot appreciate the full impact of COVID-19 on LGBTQIA+ communities, nor can we develop LGBTQIA+-tailored interventions or monitor the effectiveness of interventions until our country systematically collects sexual orientation and gender identity data with regards to COVID-19, as researchers and LGBTQIA+ medical students have urged health and policy leaders to do. 51 , 52 Dr. Cahill of Fenway Institute has called this failure “public health malpractice.” 53 At the same time that LGBTQIA+ students are experiencing discouragement from a lack of institutional and societal support, they are still being asked to participate in diversity recruitment initiatives and deliver LGBTQIA+ curricula, all while processing the minority stress and microaggressions encountered regularly in medicine.

Recommendations to support LGBTQIA+ students

We hope sharing these perspectives empowers medical schools to check on, support, and believe LGBTQIA+ students because many people in positions of power have silenced them with reminders of their invisibility and powerlessness in society during the COVID-19 pandemic. 54 Although the pandemic specifically spotlighted injustices and inequities experienced by those who are Black, inequities experienced by any minoritized or disadvantaged group would be exacerbated by the pandemic. For example, while providing platforms for students who are Black or underrepresented minorities (URM), we must keep intersectionality in mind and also elevate the voices of LGBTQIA+ students, as well as those with disabilities, non-URM racial and ethnic minorities, students from low socioeconomic backgrounds, etc. When students share anecdotes about issues related to their marginalized identity impeding them from thriving in medical school, it is important to validate and address those concerns.

Medical schools should mitigate the negative impact of disparities in responsibilities by hiring experts to create and deliver LGBTQIA+ curricula or by compensating students for their diversity-related work. One author (M.W.) partnered with her associate dean for medical education to create a minority tax elective, which formally assigns academic value to diversity work. Earned academic credits for diversity work can provide students with flexibility (e.g., mental health day, extra study time for boards) or can be redeemed during a student’s final year as nonclinical elective time. Schools are encouraged to similarly engage with students to brainstorm school-specific or individually tailored ways to offset disparities in responsibilities.

Dual-degree students

Medical students in the process of earning an MBA, MPH, PhD, or other dual degree experienced varying effects of COVID-19 on their education. Students completing theses in the winter or spring of 2020 had additional time to do so while clinical rotations were on hold. One student earning her MPH said the pandemic allowed her to volunteer at the county public health department for 3 months while clinical rotations were paused. She reflected that this opportunity would never have been possible pre–COVID-19, and it allowed her to try on a possible career path. Other students reported that their education was affected minimally, if at all, because they were working remotely already before the pandemic began.

In contrast to students who were finishing their dual degrees, students who were beginning or in the middle of dual-degree programs experienced limited access to campus resources, in-person mentorship, and professional development. The ability to walk down the hall to troubleshoot with another researcher or to flesh out new ideas was diminished as research buildings never returned to their pre–COVID-19 physical capacity limits. 55 Scientific conferences and poster sessions continued to be canceled during the 2020–2021 academic year. Weekly and monthly collaborative meetings, which are critical to the development of PhD students, did not resume. The loss of personnel, research animals, funding, and time due to the shutdown narrowed the opportunities of some students to continue their previous work.

Recommendations for supporting dual-degree students

Although students should have access to mentors and advisors within their dual-degree programs, we recommend that medical schools also reach out to students who are earning dual degrees to check on their wellness and inquire about barriers that may delay their return to medical school. With fresh sets of eyes and external perspectives, school administrators may better identify stalled projects and situations where students need interventions to maintain a realistic timeline. Schools may also be able to supplement professional networking and development opportunities that have decreased in the basic sciences, public health, or business sectors. In addition, medical schools, with their ready access to clinical expertise, can facilitate conversations with faculty in other fields to advocate for and advise how to safely reopen research buildings and classrooms. For students who cannot meet in-person, offering alternative ways to collaborate (i.e., social media, such as Clubhouse: Drop-in Audio Chat) could add means for students to share and develop their work with colleagues.

Virtual residency application cycle

The residency application timeline was delayed in 2020 to allow students extra time to choose their specialty, take required licensing exams, and gather recommendation letters. 16 This extra time was critical for many students because canceled clinical time in the spring delayed opportunities for exposure to noncore specialties. Students also appreciated that specialty organizations rallied to provide guidance to applicants and reduce application requirements. 56 Still, students were apprehensive about virtually discerning the cultures and geographic locations of programs. 57

Despite reservations, the virtual residency interview process turned out to be one of the most benign and even favorable changes of the 2020–2021 academic year. Most, if not all, students experienced cost savings because travel expenses were eliminated. Likewise, students did not have to coordinate travel between one program and the next, which increased their flexibility to attend interviews more than ever before. Also, virtual interviews were shorter; rather than taking the prepandemic average of 1.5–3 days per interview (including travel), most virtual interviews this year occurred over the course of 2–9 hours. Preinterview dinners were converted into informal virtual social hours where students could invite family to attend and also enjoy the flexibility of choosing whichever session worked for their schedule. Virtual tours, individual or small group interactions with residents, videos that demonstrate culture, updated residency websites, and packets of information about the programs were helpful tools in addition to the interview day that assisted students with gaining a feel of a program.

Recommendations for residency interviews

The reduced time and costs associated with virtual interviews were perceived as positive by many learners. We recommend that programs continue to provide as much information virtually as possible (e.g., group sessions with residents, videos, updated websites) to keep any in-person parts of the interview as short as possible. Systematic research, such as that currently underway by the National Resident Matching Program, needs to assess whether the virtual residency interview process was valued by all students and what limitations the virtual environment engendered. With data to support interest and plausibility, it may be possible to keep most or all interviews virtual and to only offer in-person visits as second look opportunities for students who are strongly considering programs or are torn between their top programs. Brainstorming other ways to reduce travel burden and time away from clinical learning is welcomed. The disruption to in-person interviews revealed improvements over the previous system and returning to an interview season exactly the same as before the pandemic is not recommended.

Conclusions

This report described challenges navigated by medical students during the COVID-19 pandemic, as well as triumphs resulting from the disruption and actionable recommendations in key areas. While the pandemic presented new challenges for medical students, it also uncovered or exacerbated longstanding problems. Our hope is that medical schools and institutions use our recommendations to create learning environments that do not depend on medical student resilience to be tenable. Our primary takeaways are for medical schools to maintain an individualized and learner-centered ethos while remaining dynamic, flexible, and ready to embrace both immediate and incremental changes. Additionally, maintaining open lines of communication and implementing policies and practices that support students’ academic, physical, and mental well-being are encouraged. Students who bear historically disadvantaged identities on the basis of race, ethnicity, sexual orientation, gender, or disability need to be engaged in decision-making conversations considering that traditionally, these students have been excluded or harmed by discriminatory policies and practices. Creative and collaborative partnerships between medical institutions and students will continue to ensure the ongoing evolution of medical education to meet the needs of learners and patients.

Acknowledgments

The authors would like to thank the Josiah Macy Jr. Foundation, Holly J. Humphrey, MD, MACP, Mark R. Speicher, PhD, MHA, Alison J. Whelan, MD, and the medical students who allowed the authors to share their stories.

Funding/Support: This work was supported by the Josiah Macy Jr. Foundation.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Contributor Information

Marie Walters, Email: [email protected].

Taiwo Alonge, Email: [email protected].

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A qualitative analysis of third-year medical students’ reflection essays regarding the impact of COVID-19 on their education

Erin l kelly, allison r casola, kelsey smith, samantha kelly, maria syl d de la cruz.

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Received 2021 May 2; Accepted 2021 Aug 22; Collection date 2021.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

The COVID-19 pandemic fundamentally changed every aspect of healthcare delivery and training. Few studies have reported on the impact of these changes on the experiences, skill development, and career expectations of medical students.

Using 59 responses to a short reflection essay prompt, 3rd year medical students in Philadelphia described how the COVID-19 pandemic affected their education in mid-2020. Using conventional content analysis, six main themes were identified across 14 codes.

Students reported concerns regarding their decreased clinical skill training and specialty exposure on their career development due to the loss of in-person experience during their family medicine clerkship. A small number felt very let down and exploited by the continued high cost of tuition while missing clinical interactions. However, many students also expressed professional pride and derived meaning from limited patient and mentorship opportunities. Many students developed a new sense of purpose and a call to become stronger public health and patient advocates.

Conclusions

The medical field will need to adapt to support medical students adversely impacted by the COVID-19 pandemic, from an educational and mental health standpoint. However, there are encouraging signs that this may also galvanize many students to engage in leadership roles in their communities, to become more empathetic and thoughtful physicians, and to redesign healthcare in the future to better meet the needs of their most vulnerable patients.

Keywords: Undergraduate medical education, COVID-19, Workforce development, Clinical training

The COVID-19 pandemic significantly disrupted medical education. Globally, many undergraduate medical schools suspended in-person classes and clinical rotations and shifted to asynchronous/synchronous learning platforms and telehealth appointments to keep patients, practitioners, and students safe [ 6 ]. This fundamental shift in the structure of medical education has had potential to enormously impact the foundational activities that guide and shape physician skill sets (e.g., in-person patient interaction, observation of physical exam skills, hands-on clinical assessment, bedside teaching). Third-year medical students, in particular, have faced a loss of clinical time and patient interaction in the crucial year of core clinical clerkships [ 2 , 6 , 11 ]. During the third year of medical school, students are exposed to different clinical rotations with the expectation that they will use these experiences to inform their selection of a specialty. Less clinical time translates to decreased exposure to fields of interest, fewer opportunities to hone clinical assessment, and less one-on-one guidance and mentorship.

Several previous COVID-19 studies focused on medical students’ views of the impact of remote learning on their education [ 6 , 10 , 11 , 13 ]. Second-year students reported the negative impact that remote learning had on their preparation and training, particularly with regards to the United States Medical Licensing Examination (USMLE) Step 1 examination and learning clinical skills [ 13 ]. Clinical educators fear that socially distant learning processes and specialty selection will have long-lasting impacts on students’ skills, empathy, and career development [ 14 ]. However, many editorials also illustrate educators’ desires to find a “silver lining” in the chaos, such as the benefit of virtual learning platforms and telehealth, the necessity of integrated public health education, and students’ extraordinary display of adaptability [ 5 , 9 , 16 ]. Perhaps even more concerning, however, is the underexplored loss of skill and career development experienced by third-year medical students during this pivotal period of clinical education. In a recent scoping review conducted by Daniel et al. [ 4 ], most undergraduate medical education research focused on surgical students, and none included those in family medicine clerkships [ 4 ]. Thus, the goal of the present study is to understand the effects of the COVID-19 pandemic on U.S. third-year medical students’ experiences of education, skill development, and career expectations through qualitative analysis. The third year of undergraduate medical education is truly foundational for clinical skill development and specialty exposure and selection. These students could feel the enduring impacts of COVID-19 in a manner distinctive from their peers. Findings from this work will explore how COVID-19 impacted the daily structure of medical education during this critical juncture.

Participants included two cohorts of third-year medical students completing their Family and Community Medicine clerkship at a large, private medical school in an urban northeastern city in the United States. For a brief period, April 13th, 2020 through June 15th, 2020, all medical students university-wide shifted to completely virtual learning. This institutional change resulted in requiring students to complete an 8-week “Clinical Continuum Course” and a 1-week “Transition to Clerkship” before returning for in-person clinical duties. In-person research and hands-on clinical learning resumed in mid- June with new institutional guidelines designed to benefit student learning while also maintaining safety precautions for COVID-19.

Cohort 1 ( n  = 29) was from June 15th to July 15th 2020 and Cohort 2 ( n  = 30) was from July 20th to August 21st 2020. Cohort 1 (C1: Mean Age = 25.8, SD  = 1.74; 12 male, 17 female) Cohort 2 (C2: Mean Age = 25.3, SD  = 1.27; 18 male, 12 female). The race/ethnicities of the 2020–2021 medical student class are 64.3% White, 24.2% Asian, 6.5% Other, 2.5% Black or AA, 2.2% choose not to disclose, 0.4% Pacific Islander. 89.1% are not Hispanic, Latino, Spanish. Five students did not respond for a response rate of 92% ( n  = 59/64).

As part of the Family Medicine Clerkship, all students are required to complete a Quality Improvement and Health Disparities Project. Students complete asynchronous online lessons on the fundamental principles of quality improvement, how to complete a Plan-Do-Study Act cycle (a model for implementing a change process), an introduction to a Community Health Needs Assessment, and a 1-1.5 hour module on health disparities in a vulnerable population of their choice (homeless, veteran, and immigrant/refugee). During their six-week Family Medicine rotation, the students must choose a process that needs improvement in health care and apply their knowledge gained regarding quality improvement and population health. The students provide a visual model of their quality improvement intervention through a process mapping assignment. They are also asked to complete a reflection assignment, which includes a discussion of how their quality improvement intervention will impact vulnerable populations. As part of a larger 10-item short essay reflection assignment that comprehensively evaluates their medical experiences and their perceptions of their patients’ social determinants of health and healthcare, students responded to the prompt: “Describe how COVID-19 has affected how you view your medical training.” Essays were between 175 and 250 words and submitted online via CANVAS at the conclusion of the clerkship rotation. The Institutional Review Board of Thomas Jefferson University determined that this study was Exempt from IRB approval and granted a waiver for consent (IRB 2405; Protocol 17E.486). All students practice reflection essay responses starting in the first year of medical school training. In the first year, students are taught to describe their experiences, then evaluate (strengths, areas for improvement, feelings, and assumptions), analyze the impacts on them personally and on the broader field, and to develop action plans, which reflects the main principles of the Integrated Reflection Cycle [ 1 ]. Students continue the practice of reflection essays in the second year of medical school, so by their third-year clerkships, they have had significant prior experience with reflection skills and techniques.

Four authors (2 with PhDs, 1 with an MD, and 1 with a BA) reviewed each transcript, highlighted key passages, and made notes of potential themes in the margins to develop the preliminary basis of our codebook per the process recommendations of Huberman and Miles [ 8 ]. We developed codes that were derived from the data (open coding) and modified them through consensus before and during our coding process while using a content analysis approach [ 7 ]. All the research team members had experience with qualitative study development and coding and had diverse training backgrounds, with degrees in psychology (PhD), public health (PhD), family medicine (MD), and anthropology (BA). After collaboratively coding 10 responses, the codebook was further refined, and 14 codes were used for analysis yielding 6 main themes (see Fig.  1 ). Two independent coders reviewed each response, and the team reconciled all coding disagreements. Analysis included monitoring of whether there were differences across the cohorts for any domains. A fifth author (with a MA in East Asian Languages and Civilizations assisted with the thematic analysis. NVivo software (version 12) was used to manage and code data. All research team members completed a series of analytic memos of the original 14 codes and synthesized them collaboratively onto the six major themes.

Summary of codebook refinement and final theme determination

Main themes

Overall, while students identified that their education was negatively impacted, didactically and clinically, both short and long-term; many noted that these experiences helped them to reflect on the profession, and their place within it. Six main themes were identified: infection fears, negative feelings of impact on education/exams; loss of skill development; adaptability; perspective change and finding meaning; public education and advocacy. Illustrative quotes are presented in Table  1 .

Illustrative Quotes of the Six Main Themes

Fear about infection

Interestingly, student concerns about COVID-19 infection were uncommon. Only one student described his/her disappointment in the medical field for failing to provide adequate PPE for staff and anger that healthcare workers were silenced for speaking out about being endangered due to this. A small number from both cohorts discussed their fears of becoming infected with COVID-19 personally, which consequently increased their stress, anxiety, and impaired concentration. Two students expressed concern about potentially spreading the COVID-19 infection to family or friends and how that impacted their decisions to be around their families. While these students detailed their fears only, one student found a way to make this a meaningful learning experience by increasing awareness of their body language, tone of voice, and facial expressions for creating better rapport with patients.

Negative feelings of impact on education/exams

Many students conveyed frustration, dissatisfaction, and even anger regarding the adverse impact of COVID-19 on their medical school education. Students from both cohorts expressed this dismay as frustration over having their board exams delayed or rushed, losing clinical time with patients, and receiving less one-on-one attention/guidance from instructors. The same students also discussed their concerns about the limits of virtual courses, how larger cohort sizes of rotations adversely impacted their instruction quality (due to students’ rescheduling and delay of clerkships), and the overwhelming fear that their “ medical education is not good enough for [them] to become the doctors that [they] want to be in the future ” (C2 R19). These worries resulted in a few students directly discussing their anger that their tuition price point had remained the same despite the decrease in quality of their training, leaving them feeling exploited and anxious about their futures. Additionally, while many solely focused on detrimental changes seen in their own education, a few identified the larger causes of these changes, like the economic chain of personal protective equipment distribution. Some respondents also identified the impacts of COVID-19 on student expectations and requirements. Two students expressed that balancing rescheduled exams with rotations was extremely stressful, while several others across both cohorts discussed how quickly they had to adapt to shifting to virtual instruction, learning new protocols, and adjusting to a new reality of medical education.

Loss of skill development

Most students viewed the scarcity of in-person training as detrimental for skill development, leaving some apprehensive about their future careers as physicians. Although the vast majority of students (14 C1, 20 C2) remained positive regarding their experiences, focusing on the safety of themselves and patients, many also noted less face-to-face interaction impaired their ability to build patient rapport. One student noted that :“The limits on patient contact are unfortunate but necessary for our and our patients’ safety.” (C1 R13).

Several students (4 C1, 2 C2) expressed dissatisfaction with online education as a substitute for clinical experience, stating “in all there is a decreased amount of quality teaching time due to the lack of clinical time.” [C2 R16] This lack of clinical experience and shortened rotations contributes to a decrease in skill development and specialty exposure, creating fear of long-term issues for career advancement as physicians, even if disruptions were short.

One less week could mean the difference from exposure to a rare surgery that may make you want to join a field of medicine that you were otherwise thinking that you did not want to do. [C2 R3]

Concerns about their loss of skill development intertwined with their concerns about their future careers. Many students expressed that COVID-19 created negative feelings toward their future, and several students (largely from Cohort 1) expressed concerns about their career development (…“ ultimately, I feel like my potential is being limited a ton .” [C1 R14]); with most linking this to their own and other students’ lack of clinical training opportunities posing issues for the field long-term. In a few cases, students’ fears regarding their preparation led them to question whether they should remain in medicine.

Need for adaptability

A little less than half of students noted adaptability as a requirement for the medical field and for students themselves, and this perception did not differ across the cohorts. The greater preponderance of responses focused on individual adaptability while a few acknowledged how both individuals and systems were affected.

Medical training during the time of COVID-19 is a lesson in flexibility. In fact, I would argue that the entirety of 2020 has been a lesson in flexibility. The past 6 months have been unimaginable and unpredictable, and as such, we've had to pivot in our daily lives and make major adjustments to education delivery. (C2- R26)

Some described practical lessons learned, such as adapting to novel or dynamic health care settings and becoming flexible and comfortable with uncertainty. Several students remarked on the medical system’s adaptability but noted it in separate ways. For example, two students focused on its ability to adapt quickly and effectively to new protocols and challenges, while three students focused on the adoption of telehealth. A couple of students were proud to see how physicians stepped up in the face of COVID-19 while others described adapting new ways of interacting with patients and developing meaningful connections, with implications for their approach to clinical care in the future.

Perspective change and finding meaning

Despite the many adverse effects of the pandemic on their education, most students from both cohorts cognitively reframed their experiences to find deeper meaning in their experiences or discussed how their perspectives had changed in positive ways. However, there was considerable range in the students’ areas of focus. Some students reflected on how they will change their approach to training, patients, and medicine, whereas others considered how it reshaped their perspectives on the medical field and the roles of physicians in society.

Primarily, students in Cohort 2 discussed perspective changes regarding their training, including how COVID-19 helped them to develop skills beyond what they would have learned in didactic training --the need to adapt, manage uncertainty, maximize each moment, value skills beyond clinical treatment alone, and face their future in medicine fearlessly.

Some students juxtaposed their appreciation for developing new skills and perspectives against the backdrop of their decreased skill development or time in clinic. As noted by one student,

COVID-19 has made it harder to meet the quantity of clinical experiences (less face to face time with patients), but I have counterbalanced this by focusing on the quality of my time with patients. (C2 R11)

A small subset of students found new appreciation for the values of paying attention to their interactions with patients, such as “ I also appreciate how much extra information a physician or student can get about a patient from physically observing affect, posture, etc. ” (C2 R2). This manifested as seeing the importance of building patient connections, the benefit of in-person care to foster face-to-face interactions, and the need to pay attention to tone of voice, body language, and general facial expressions to ensure the best patient connection possible.

A smaller number of students also discussed how the pandemic changed their perspective on the need for systematic healthcare changes including greater attention to health disparities and the importance of team-based care in a health system. It also changed some students’ perspectives on the value of public health education, as several students in Cohort 1 commented on the significance of public health perspectives and initiatives.

Desire to be public educators/advocates

Many students, predominately in Cohort 2, described an urgent need for physicians to educate the public in ways that are more approachable. Four students emphasized the role of physicians as health advocates, as illustrated by one student that “ it is our job as physicians to advocate…with a ferocity ” (C1 R24). These students discussed that medical trainees need to mobilize to influence the community, advocate for healthcare delivery, address social determinants and gain additional resources for vulnerable populations, and to “ think more about how to work past conspiracy theories with patients ” (C2 R28). Another student stated that future generations of physicians have a responsibility to improve health care and need to use quality improvement tools and concepts to accomplish this.

In their reflection essays, the third-year medical students described the significant impacts that COVID-19 had on their clinical education and on their perspectives about the field of medicine. Many students primarily focused on how the COVID-19 pandemic negatively affected their clinical skill training, preparation for exams, specialty exposure, and career development. However, students simultaneously re-conceptualized their roles as learners, providers, educators, and advocates. Most students cognitively reframed their experiences, reevaluating the skills, values, roles, and leadership within the medical field. They described this perspective in terms of a need for adaptability, pride in their profession, and a desire to assume a stronger advocacy role in the future, which reflects considerable resiliency among students as well as potential signs of how these future providers may see their roles in healthcare evolving in the future.

Similar to the few previously reported quantitative studies on these domains [ 2 , 11 ], our study found that students expressed concerns that a lack of clinical time and exposure would affect their training and future careers. Moreover, many students attributed feelings of frustration, disappointment, and apprehension related to their preparation for USMLE exams, clinical and communication skills, and specialty selection. Some students in our study also reported difficulty balancing the stressors of rescheduled exams with their rotations, as well as having to adapt to new protocols and guidelines. We found that some respondents also expressed anger and feelings of exploitation regarding their tuition fees when the institution was unable to provide the comparable degree of training that it had previously. This is in line with the numerous class action tuition lawsuits nationwide for missed essential components of the curriculum, such as lectures, patient cases, and procedures [ 17 ]. These findings could indicate that these future physicians may be a higher risk for increased stress, anxiety, and depression, and that the field will need to monitor physician risk more closely for mental health issues, suicide risk, and burnout as the enduring effects of these experiences continue to affect students. Despite challenges of the COVID-19 pandemic, students in our study tried to find the “silver linings” and reframed their experiences and perspectives in a positive way that reflects the development of their professional identity formation– they identified the benefit of adaptability, pride in their profession, and a desire to become stronger advocates for patients in the future. Students in other studies have described a similar perspective change after having a transformative experience, including an increase in feelings of advocacy, empowerment to create change, and a commitment to action [ 3 , 12 , 15 ]. While there were few differences between the cohorts, students in cohort 2 in particular described paying closer attention to each and every clinical encounter, focusing on quality and not quantity. They appreciated every nuance of communication, verbal and nonverbal, given the difficulty of communicating behind a mask. The students were grateful for the opportunity to do telehealth since it gave them the chance to have clinical “face time” with patients. Similarly, in a previous study, the majority of students who participated in telehealth expressed increased motivation and appreciation for being able to participate in patient care [ 13 ]. Despite the deleterious mental health effects noted above, it is possible that students may have developed important coping strategies that will help them to have greater resilience over time. It will be important to monitor in future research if these experiences sensitized students to their patients’ social determinants of health and if patients rate the empathy of these physicians as greater than those in other cohorts.

We found that students recognized how the pandemic not only affected them as individuals, but also the surrounding systems. Students described feeling called to action, and a sense of pride to be in the medical field. They expressed that they could serve a critical purpose as a physician and advocate. This is similar to efforts by students in other parts of the country who have felt called to action – helping with donations for PPE, participating in food drives, calling patients to provide education and follow up care, or delivering food and prescriptions [ 16 ]. It will be important to track in the future if these experiences are leading to long-term changes in the roles that healthcare providers have in advocating for individual patients and at a more systemic level through public policy and health care reform. While medical students are trained to recognize the social determinants of health, these experiences in the community may have sensitized these cohorts to engage in strategies to ameliorate them more directly in the future.

Implications for medical education

Our study is unique in that it focuses qualitatively on the experiences of third year students in their clinical year, and students’ self-reported decrease in clinical skills training has important implications for their futures as residents and physicians. Because of this lack of clinical exposure, educators will need to be innovative for future curricular development, particularly in the clinical years, to find ways to effectively catch students up to the level they need to be prior to internship. Medical educators will need to continue to utilize technology to assist with learning as well as develop reliable assessment tools to determine clinical competency. Because career development was a major concern for students, educators will need to expand opportunities for career counseling, mentorship, and networking. In a climate where students have had less specialty exposure, specialty interest groups will be even more important for students to learn about specialties and meet attendings/residents as role models. Additionally, while many students feel “called” to help, they are looking for guidance on the best way to engage and serve their communities. Amidst the many competing educational priorities, we need to make sure that we are supporting and listening to the needs of our students.

Limitations and future directions

There are limitations to our study. The findings of this study may not be generalizable because it was conducted in only one medical school and our sample was predominately white. Thus, more diverse medical students will possibly face different concerns or view them differently than our sample . The students also had word restrictions on their essay question and were asked to keep it “reflective.” Our question was open-ended, to allow students to explore their thoughts. Lastly, it was not possible to triangulate responses with other data on this sample, though our data is consistent what other studies and news reports have found with medical students in other years of study and specialties, which supports their credibility.

Future directions include additional studies long-term to measure the competencies of students whose clinical time was directly affected by the pandemic. We also know little about how we are supporting the current trainees caught in the crossfire between school, hands-on training, and personal/family stressors. Future efforts should focus on developing standardized assessment to identify clinical gaps and address those gaps, as well as providing effective mentorship and career counseling for these students. Medical educators also need to provide support and carefully monitor the well-being and wellness of students who may still be struggling in the aftermath of the pandemic.

The COVID-19 pandemic had a profound effect on clinical education for 3rd year medical students. While students reported negative impacts on their education and career development, they also highlighted the positives of learning to adapt, finding meaning in their experiences, and a desire to serve as public health educators and advocates. It will be valuable to see how these students integrate these lessons in their practice once they become independent physicians.

Acknowledgments

Disclaimers, previous presentations, authors’ contributions.

ELK analyzed qualitative data and was a major contributor in writing the manuscript. ARC contributed to the design of the study, analyzed qualitative data, created the figure, and was a major contributor in writing the manuscript. KS analyzed qualitative data and was a major contributor in writing the manuscript. SK analyzed qualitative data and was a major contributor in writing the manuscript. MDC contributed to the design of the study, analyzed qualitative data, and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.

This work was funded by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a Primary Care Medicine and Dentistry Clinician Educator Career Development Awards Program, Grant Number K02HP30821. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available due to the data not being cleaned of information that may inadvertently identify participants but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate.

This study was determined as Exempt by the Institutional Review Board of Thomas Jefferson University (IRB 2405; Protocol 17E.486).

The requirement for informed consent was waived by the IRB.

All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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