The perceived impact of the COVID-19 pandemic on medical students’ future careers

Introduction

The Coronavirus disease-2019 (COVID-19) pandemic created unforeseen obstacles for humankind across the globe. Tasks that were once mundane, such as scheduling test dates, have now become difficult or unsafe.¹ Importantly, medical students have been uniquely affected. For many months, the Association of American Medical Colleges (AAMC) advised medical schools across the United States to pause in-person education in order to slow the spread of the virus.² Most medical schools transitioned pre-clinical curricula to an online format, embracing learning from a distance. Unfortunately, clinical years, where medical students serve directly on medical teams rather than in a classroom, were more difficult to transfer online.³ To further complicate the situation, mandatory standardized tests such as USMLE Step 1 and Step 2 were postponed or cancelled for many students.⁴ Many medical students have also been unable to continue their scientific research and volunteer opportunities in the community.⁵ Such experiences are crucial in career development as they help shape students’ interests.

One learning theory that forms the theoretical framework for this study is connectivism, which emphasizes the importance of technology and socialization for building an educational framework.⁶ It especially highlights that learning is a continuous process that requires nurturing connections between study areas.⁷ Interestingly, this theory supports both virtual learning and in-person learning, muddying the potential outcomes of a transition from clinical rotations to e-learning. While different students have been affected by COVID-19 in various ways,⁸ the aggregate impact of the pandemic will resonate throughout both medicine and society for years to come. Hence, we sought to study the implications of the COVID-19 pandemic on students' career decisions. In particular, we aimed to investigate the impact of COVID-19 on medical students’ perspectives towards medicine. We explored whether the pandemic may have altered students’ professional and personal goals, such as whether interests in specialties had changed, whether they were questioning medicine as a career, and whether they felt well-educated on pandemics and infectious diseases. We also aimed to determine students’ reactions to changes in licensing exams and how this uncertainty might influence their careers.

Methods

Results

Of the 585 eligible medical students, we received 83 total responses. Seven responses were excluded because only the first question was answered, leaving a final sample of 76 responses (n = 76) (13% response rate). Most respondents were women (43/76, 57%), and the average age was 25.68 (± 2.45 standard deviation (SD)). In this sample, 51% (39/76, 51%) were white, followed by 29% (22/76, 29%) Asian or Pacific Islander, 8% (6/76, 8%) multi-racial, and 8% (6/76, 8%) Black or African American. Many students had received prior degrees including two with PhDs (2/76, 2%), three with Master of Public Health (MPH)s (3/76, 4%), three with Master of Science (MS)s (3/76, 4%), and one with a Master of Arts (MA) (1/76, 1%). No students (0/71, 0%) were offered an early graduation option by their medical school at the height of the pandemic (Table 1).

A series of COVID-19 related questions were included in the survey (Table 2) (Underlying data).⁹ When asked the question ‘Are there currently restrictions in the place where you live?’, 50% (50/100, 50%) of students responded ‘My town/city is in the process of easing restrictions’, as well as 46 students (46/100, 46%) who responded ‘Social isolation is recommended by state or local authorities. Of those who responded, 25% (25/71, 35%) had friends or family members who had been diagnosed with COVID-19, although none (0/71, 0%) were themselves diagnosed with COVID-19. In the overall cohort, most respondents (37/71, 52%) were leaving their home four or more times per week for work, shopping, or other reasons.

Several survey questions (Table 3) covered student well-being. On average, students somewhat agreed with currently feeling that they have a definite role among family and friends (Mean ± SD; 3.89 ± 1.00), that they are useful to family and friends (3.80 ± 1.13), that they are being listened to (3.87 ± 0.92), and that they know what is going on with their family and friends (4.18 ± 0.86). Students felt neutral regarding having more time to explore research projects (3.06 ± 1.18) and hobbies (3.43 ± 1.28), as well as more time to spend with friends or family members (3.34 ± 1.37). Table 3 shows additional responses regarding student well-being. In a section of our survey that permitted free text, students shared their difficult experiences. An example of one experience was (Extended data)¹¹:

Students were also asked about their medical education prior to COVID-19 and their perceived obligations (Table 3). When questioned about their medical education regarding epidemics, they somewhat agreed that their education was adequate (3.49 ± 1.08). Students felt neutral regarding their confidence in the healthcare system (3.34 ± 1.37) and their medical school’s administration (3.12 ± 1.33). Most survey respondents somewhat disagreed that they considered quitting medical school during the pandemic (1.55 ± 1.10). The students somewhat agreed that they view the field of medicine more positively since the onset of the COVID-19 pandemic (3.60 ± 1.09), but they felt neutral regarding their responsibility to volunteer during the pandemic (3.37 ± 1.12). Table 3 indicates additional responses covering medical education prior to COVID-19 and perceived obligations.

There were multiple survey questions regarding obstacles to mentorship and residency preparation (Table 3). Respondents somewhat agreed that they would be unable to explore other specialties and find their best fit (3.55 ± 1.32), as well as being unable to network with potential mentors (3.79 ± 1.15). Students were neutral regarding the level of comfort forming relationships with faculty members (3.11 ± 1.28), asking for letters of recommendation (2.97 ± 1.22), and level of competitiveness for their desired field (2.71 ± 1.08). In terms of their career, students were neutral that losing the ability to participate in away rotations would limit their career trajectory (2.89 ± 1.22), that they would not perform as well on graded clerkships as before (3.13 ± 1.37), and that they would not have the opportunity to complete sub-internships or advanced electives at their institution (3.18 ± 1.34).

We were also curious as to whether the pandemic had caused students to switch their preferred specialty and the effects of the pandemic on the standardized exams, Step 1 and Step 2. We found that the minority (4/66, 6%) of students had considered changing their specialty. For those who had considered changing, these swaps were from emergency medicine to neurosurgery, otolaryngology to internal medicine, neurosurgery to internal medicine, and internal medicine to anesthesiology (Figure 1). Six students (6/66, 9%) absolutely believed that the COVID-19 pandemic would negatively impact their current or future Step 1 score, while 13 (13/66, 19.6%) did not believe that it would. The majority (37/66, 56.0%) of students did not believe the pandemic had negatively affected their current or future Step 2 score. Neither group felt strongly that their Step 1 (3.25 ± 1.05) or Step 2 (2.81 ± 1.02) score would deter them from future career opportunities (Table 4). One student shared their experience with the testing sites during the pandemic (Extended data)¹¹:

Figure 1. Have you considered changing your preferred specialty choice since the onset of the COVID-19 pandemic?

Discussion

In this cross-sectional survey, we explored the important topic of how the COVID-19 pandemic has influenced medical students’ professional goals. We analyzed 76 responses from diverse medical students with various educational backgrounds. Most students perceive barriers in their career pathway, including the ability to explore different specialties to discover their best fit or find a chance to network with mentors. However, despite these obstacles, most students feel strongly to continue in medicine on the same pathway that they began. These findings align with several other studies conducted nationally and internationally.^12,13,14

We found that many students lived in a town or city that was in the process of easing restrictions (50/100, 50%), but that social isolation was still recommended by state or local authorities (46/100, 46%). Some students (11/71, 16%) were even living with high-risk populations. These factors led medical schools to pause in-person learning. Though transitioning classes to an online format might seem effective, the impact of isolated learning has already taken an effect on students. Even when learning has continued in a digital, socially distanced format, studies have shown that students are experiencing disheartening decreases in overall work performance and emotional detachment.¹⁵ This is concerning, considering the highest quality of patient care comes from doctors working effectively as teams.¹⁶

Interestingly, students in our study did not feel they had more or less time to spend on research projects (3.06 ± 1.18), on hobbies (3.43 ± 1.28), or with friends and family (3.34 ± 1.37). Although students did not feel an increase or decrease in time spent on research projects, they did feel strongly that other opportunities for career preparation were stunted. Respondents somewhat agreed that they would have difficulty exploring other specialties to find their best fit (3.55 ± 1.32), as well as being unable to network with potential mentors (3.79 ± 1.15). Overall, however, respondents were neutral when questioned about their competitiveness for their desired field (2.71 ± 1.08). Further, students might have felt that their Step 1 or Step 2 scores were affected by the pandemic, but students did not feel strongly that these scores would deter them from future career opportunities. These findings indicate that while certain experiences have been limited by the pandemic, students generally see themselves on the same path that they initially envisioned. We found that only the minority (4/66, 6%) of students had considered changing their specialty. This is less than a previous study’s finding that one-fifth of medical students would change their choice of specialty.¹⁷ This study, by Byrnes et al., involved a larger sample size including students at various institutions, but the findings showed that region of the US did not alter whether the pandemic affected students’ specialty choices. Furthermore, our study found that students felt neutral (2.97 ± 1.22) in asking for letters of recommendation, whereas the respondents in the Byrnes et al. study posed that as their main cause of specialty change. In the future, students may benefit from earlier exposure to different specialties in a virtual platform. One example would be each specialty creating a “Day in the Life” video at various institutions, which would expose students to the daily routine of each and help them make a decision about which experiences suited them best.

In addition, most survey respondents somewhat disagreed that they considered quitting medical school during the pandemic (1.55 ± 1.10). Coupled with the data that these students view the field of medicine more positively since the onset of the COVID-19 pandemic (3.60 ± 1.09), this suggests a resilient attitude by the respondents. This highlights why certain medical schools across the country offered their students a chance to graduate early and join the frontlines tackling the COVID-19 pandemic; medical students want to practice medicine, and they understand the need for dedicated providers.¹⁸ In addition, many previous studies have provided suggestions for engaging medical students throughout this pandemic,^19,20 and it is reassuring to see medical students taking a stand for their communities and their education by staying engaged.^21,22

Though our sample population offers a unique perspective from each student, our study comes with certain limitations. The study is sensitive to selection bias for students that responded to and completed the survey, potentially limiting the generalizability of our findings from all students. Our response rate of 13% may reflect some non-responder bias as well as survey fatigue, as our survey was sent at a time when many students were experiencing distressing times. A more robust sample size might provide additional and more diverse viewpoints. Additionally, all respondents came from a single institution in the mid-Atlantic region. Students at institutions in regions that experienced very different case numbers, such as in the Midwest, South, or West, might have different experiences that alter their career trajectories. Lastly, there were a handful of respondents who left certain questions unanswered, leaving us with missing information for that student.

Conclusion

Despite the challenges in distance-learning and career preparation that many are now experiencing, our survey study finds that students still have their minds set on achieving their pre-determined goals. We are hopeful that the hardships brought on by the COVID-19 pandemic have strengthened the next generation of physicians and that future patients benefit from their dedication.

Data availability

Author contributions

All authors were involved in the conceptualization, investigation, methodology, project administration, supervision, validation, visualization, writing of the original draft, and reviewing and editing the subsequent drafts. HM and CV performed data curation and formal analysis. SMS was involved in funding acquisition, resources, and software.