Frank Veronica, Doshi Anjali, Demirjian Natalie L, Fields Brandon K K, Song Catherine, Lei Xiaomeng, Reddy Sravanthi, Desai Bhushan, Harvey Drayton C, Cen Steven, Gholamrezanezhad Ali
Semmelweis University Faculty of Medicine, Semmelweis University Faculty of Medicine, Budapest 1085, Hungary.
Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States.
World J Virol. 2022 May 25;11(3):150-169. doi: 10.5501/wjv.v11.i3.150.
The coronavirus disease 2019 (COVID-19) pandemic altered education, exams, and residency applications for United States medical students.
To determine the specific impact of the pandemic on US medical students and its correlation to their anxiety levels.
An 81-question survey was distributed email, Facebook and social media groups using REDCap. To investigate risk factors associated with elevated anxiety level, we dichotomized the 1-10 anxiety score into low (≤ 5) and high (≥ 6). This cut point represents the 25 percentile. There were 90 (29%) shown as low anxiety and 219 (71%) as high anxiety. For descriptive analyses, we used contingency tables by anxiety categories for categorical measurements with chi square test, or mean ± STD for continuous measurements followed by -test or Wilcoxson rank sum test depending on data normality. Least Absolute Shrinkage and Selection Operator was used to select important predictors for the final multivariate model. Hierarchical Poisson regression model was used to fit the final multivariate model by considering the nested data structure of students clustered within State.
397 medical students from 29 states were analyzed. Approximately half of respondents reported feeling depressed since the pandemic onset. 62% of participants rated 7 or higher out of 10 when asked about anxiety levels. Stressors correlated with higher anxiety scores included "concern about being unable to complete exams or rotations if contracting COVID-19" (RR 1.34; 95%CI: 1.05-1.72, = 0.02) and the use of mental health services such as a "psychiatrist" (RR 1.18; 95%CI: 1.01-1.3, = 0.04). However, those students living in cities that limited restaurant operations to exclusively takeout or delivery as the only measure of implementing social distancing (RR 0.64; 95%CI: 0.49-0.82, < 0.01) and those who selected "does not apply" for financial assistance available if needed (RR 0.83; 95%CI: 0.66-0.98, = 0.03) were less likely to have a high anxiety.
COVID-19 significantly impacted medical students in numerous ways. Medical student education and clinical readiness were reduced, and anxiety levels increased. It is vital that medical students receive support as they become physicians. Further research should be conducted on training medical students in telemedicine to better prepare students in the future for pandemic planning and virtual healthcare.
2019年冠状病毒病（COVID-19）大流行改变了美国医学生的教育、考试和住院医师申请。
确定该大流行对美国医学生的具体影响及其与他们焦虑水平的相关性。
使用REDCap通过电子邮件、Facebook和社交媒体群组分发了一份包含81个问题的调查问卷。为了调查与焦虑水平升高相关的风险因素，我们将1-10分的焦虑评分分为低（≤5）和高（≥6）两类。这个切点代表第25百分位数。有90人（29%）显示为低焦虑，219人（71%）为高焦虑。对于描述性分析，我们使用按焦虑类别划分的列联表进行分类测量，并进行卡方检验，对于连续测量则使用均值±标准差，然后根据数据正态性进行t检验或Wilcoxon秩和检验。使用最小绝对收缩和选择算子来选择最终多变量模型的重要预测因素。通过考虑学生在州内聚类的嵌套数据结构，使用分层泊松回归模型来拟合最终的多变量模型。
分析了来自29个州的397名医学生。大约一半的受访者表示自大流行开始以来感到沮丧。当被问及焦虑水平时，62%的参与者给出的评分在7分或更高（满分10分）。与较高焦虑评分相关的压力源包括“担心如果感染COVID-19就无法完成考试或轮转”（相对风险1.34；95%置信区间：1.05-1.72，P = 0.02）以及使用心理健康服务，如“精神科医生”（相对风险1.18；95%置信区间：1.01-1.3，P = 0.04）。然而，那些居住在将餐厅运营限制为仅外卖或送餐作为实施社交距离唯一措施的城市的学生（相对风险0.64；95%置信区间：0.49-0.82，P < 0.01）以及那些选择“不适用”所需经济援助的学生（相对风险0.83；95%置信区间：0.66-0.98，P = 0.03）焦虑程度较高的可能性较小。
COVID-19在许多方面对医学生产生了重大影响。医学生的教育和临床准备程度降低，焦虑水平上升。医学生在成为医生的过程中获得支持至关重要。应进一步开展关于对医学生进行远程医疗培训的研究，以便更好地让学生为未来的大流行规划和虚拟医疗做好准备。
