Impact of the COVID-19 pandemic on Florida medical students’ wellbeing and academic experience during “lockdown”

Abstract

Introduction: The global pandemic of coronavirus disease 2019 (COVID-19) has continued to demonstrate considerable impacts on all aspects of life, as well as mental health across populations. Medical students may be considered a particularly vulnerable population during the COVID-19 pandemic due to the compounding mental stress of a demanding medical education.
Methods: A cross-sectional online survey was designed for medical students in the state of Florida, USA, to collect their perceptions of the impact of COVID-19 on their personal daily habits, perceived social connectedness, academic outlook, and anxiety levels using a General Anxiety Disorder 7-item (GAD-7) scale.
Results: From the ten medical schools in Florida, 96 students responded. 94% of student respondents felt the COVID-19 pandemic impacted their academic experience, but only 55% of students felt their medical school adequately mitigated the negative effect of the pandemic on their education, psychological well-being, and personal health. GAD-7 analysis revealed 36 students with mild, 15 with moderate, and 6 with severe anxiety symptoms. Students rated interruption of daily habits and feeling others were not following health guidelines as the most influential factors for their increased anxiety. Factors related to decreased anxiety were communication with family, practicing relaxation techniques, and avoiding public exposure.
Discussion: Increased levels of anxiety were common amongst students during the pandemic. Students should be encouraged to seek appropriate resources and outlets to mitigate the effects of anxiety on their psychological well-being and academic success.

Full text

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Impact of the COVID-19 pandemic on Florida
medical students’ wellbeing and academic
experience during “lockdown”
Shadi A. Baajour
Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
Waseem Wahood
Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
Kate J. F. Carnevale (  kcarneva@nova.edu )
Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
Research Article
Keywords:
Posted Date: April 19th, 2022
DOI: https://doi.org/10.21203/rs.3.rs-1562079/v1
License:   This work is licensed under a Creative Commons Attribution 4.0 International License. 
Read Full License

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Abstract
Introduction: The global pandemic of coronavirus disease 2019 (COVID-19) has continued to
demonstrate considerable impacts on all aspects of life, as well as mental health across populations.
Medical students may be considered a particularly vulnerable population during the COVID-19 pandemic
due to the compounding mental stress of a demanding medical education.
Methods: A cross-sectional online survey was designed for medical students in the state of Florida, USA,
to collect their perceptions of the impact of COVID-19 on their personal daily habits, perceived social
connectedness, academic outlook, and anxiety levels using a General Anxiety Disorder 7-item (GAD-7)
scale.
Results: From the ten medical schools in Florida, 96 students responded. 94% of student respondents felt
the COVID-19 pandemic impacted their academic experience, but only 55% of students felt their medical
school adequately mitigated the negative effect of the pandemic on their education, psychological well-
being, and personal health. GAD-7 analysis revealed 36 students with mild, 15 with moderate, and 6 with
severe anxiety symptoms. Students rated interruption of daily habits and feeling others were not
following health guidelines as the most inuential factors for their increased anxiety. Factors related to
decreased anxiety were communication with family, practicing relaxation techniques, and avoiding public
exposure.
Discussion: Increased levels of anxiety were common amongst students during the pandemic. Students
should be encouraged to seek appropriate resources and outlets to mitigate the effects of anxiety on their
psychological well-being and academic success.
Introduction
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which causes coronavirus disease 2019
(COVID-19), was rst identied in December 2019 [1]. As of August 12, 2020, it was responsible for over
737,417 deaths around the world according to the World Health Organization (WHO), and the state of
Florida (FL) in the United States of America (US) reported over 65,000 cases and 2,712 deaths. The US
declared a “State of Emergency” in March of 2020, and in the same month, FL announced an executive
order to limit non-essential travel and business known as the stay-at-home or “lockdown” order. According
to the State of Florida Department of Labor, there was a record-high number of requests for
unemployment benets within the state, indicating signicant stress on individuals from all
socioeconomic backgrounds. Medical students are a particularly vulnerable population with high levels
of stress due to the amount of time spent studying along with personal pressures inuenced by high
expectations [2]. Even prior to the global pandemic, medical education has been shown to signicantly
affect stress levels due to factors such as role transition, decreased sleep, relocation, and feelings of
isolation [3]. A prospective cohort study from 2010 analyzed 740 interns across 13 U.S. hospitals and
found that the incidence of depression increased from 3.9% to 25.7% during their internship year [4].

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Thus, analyzing the issues that may be plaguing medical students during a pandemic, and acquiring their
attitudes and perspectives, is an integral part of furthering our understanding in this eld.
Additionally, during the pandemic, medical schools have had to transition both pre-clerkship lectures and
clerkship didactic sessions to online teaching modalities. A cross-sectional survey of medical students
across 40 United Kingdom (UK) medical schools evaluated the benets and barriers of virtual curriculum.
Students reported a perceived benet of increased exibility, but a proportion of students cited family
distraction and poor internet connection to be barriers to their education [5]. However, the additional
impacts of online classes on medical students’ psychological well-being was not analyzed.
The aim of this study is to explore the thoughts of Florida medical students during the Florida stay-at-
home “lockdown” order on their personal daily habits, perceived social connectedness, academic outlook,
and anxiety levels. With this information, we hope to educate medical students regarding the impact that
an unexpected interruption to medical school curriculum can have, as well as avenues medical schools
can explore in the future to navigate similar circumstances.
Methods
Study rationale
       A cross-sectional research study was designed to survey medical students who were enrolled in
the state of Florida as of March 2020, when COVID-19 led to declaration of a national emergency in the
US. Due to the transition to online learning by every medical school in the state of Florida at that time, the
need to understand how the transition to online coursework impacted medical students necessitated
development of a survey that queried medical students in Florida about their perceptions of the impact of
the pandemic on their medical education and mental health.
Study design
The survey had ve broad categories. After obtaining students’ consent to participate, basic demographic
information was gathered. The survey then questioned students on their perceptions of how their daily
habits had changed due to the COVID-19 pandemic (much less, less, no change, more, much more). The
third section surveyed students’ general knowledge and sources of information regarding COVID-19. Next,
students were asked to report effects of the COVID-19 pandemic on their personal safety, social
connectedness, academic success, and their perception of their individual medical school’s actions to
mitigate the negative impact of the pandemic on students. Text boxes allowed for subjective, qualitative
responses. Finally, we surveyed participants’ anxiety levels by administering a General Anxiety Disorder 7-
item (GAD-7) scale, with each item coded from zero to three, per the frequency of different anxiety
symptoms. A score of 10 or greater is diagnostic of general anxiety disorder (GAD) with a sensitivity of
89% and a specicity of 82%[6]. We asked participants to specify what they believed had caused an
increase or decrease in their anxiety levels. Our study was deemed exempt by the Nova Southeastern
University Institutional Review Board (IRB # 2020-292) and was distributed online via school aliated

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emails using REDCap (Research Electronic Data Capture) software, with the help of participating medical
school student affairs oces. Students were able to submit their response online from June 18th to
August 10th, 2020 [7].
Subjects’ selection
The medical schools surveyed were: Florida International University Herbert Wertheim College of Medicine
(FIU), Florida State University College of Medicine (FSU), Nova Southeastern University Dr. Kiran C. Patel
College of Osteopathic Medicine (NSU DO), Nova Southeastern University Dr. Kiran C. Patel College of
Allopathic Medicine (NSU MD), University of Central Florida College of Medicine (UCF), University of
Florida College of Medicine (UF), University of Miami Miller School of Medicine UM), and University of
South Florida Health Morsani College of Medicine (USF). While also located in Florida, Florida Atlantic
University Charles E. Schmidt College of Medicine (FAU) and Lake Erie College of Osteopathic Medicine -
Bradenton Campus (LECOM) declined to participate in the study. The total population of medical
students in the state of Florida at the time was 5744. The survey was distributed through the Oce of
Student Affairs at each medical school, utilizing student email listservs to forward the survey web link, an
informational yer, and the researchers’ contact information. The survey was available online for 8
weeks.
Statistical Analysis
GAD-7 categorical scores were created. A score of 0-4 was indicative of no observed anxiety, 4-9 denoted
mild anxiety, 10-14 was moderate, and 15-21 was indicative of severe anxiety. All categorical variables
were reported as n (%) and all continuous variables were reported as median (intraquartile range) or mean
(standard deviation). A Fisher’s exact test was used to assess if any of the demographic variables,
including age, gender, school, year in medical school, and number of people residing in respondents’
households, were confounders for the GAD-7 categorical scores.
Qualitative Analysis
        Free responses collected from student respondents were analyzed holistically for common
themes across respondents, as well as analyzed by WordCloud online software to generate graphical
representations of the most commonly used words or word-groupings (displayed as larger relative font
size) amongst all responses in the categories of impact on medical school experience, student
perceptions of what medical schools did well, and student perceptions of areas for improvement for their
medical schools during the pandemic.
Results
Demographic Information
        As can be seen in Supplemental Table S1 in the supporting information, a total of 96 responses
were received: 32 (33.3%) from UF; 25 (26.0%) from NSU MD; 16 (16.7%) from FSU; 11 (11.5%) from UCF;

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7 (7.29%) from NSU DO; 5 (5.21%) from FIU; and no responses were obtained from USF or UM, in addition
to FAU and LECOM which declined to participate (Table S1). As seen in Supplemental Table S1, most of
the student respondents were in the age range of 22-25 years old (n=58, 60.4%), and 59 respondents
identied as female (61.5%), with one student responded as “not listed” as their gender. Third-year
students made up most of the respondents (n=36, 38%). Approximately on-fth of respondents reported
living alone during the pandemic (n=19, 19.8%), with most respondent reporting one 30.2% (n=29) or
more housemates, and only 10.4% (n=10) reporting ve or more individuals, including themselves,
residing in their household during the pandemic (Supplemental Table S1).
Personal Habits
        Some of the personal habits that increased in frequency during the pandemic included hand-
washing for at least 20 seconds (n=55, 58% responded with “More”), using more sanitizers (n=41, 42.7%
responded with “More”), using personal protective equipment (PPE: such as masks or gloves) in public
(n=76, 79.2% responded with “Much more”), avoiding non-essential travel (n=47, 49.0% responded with
“Much More”), maintaining distance from non-essential businesses (n=48, 51.1% responded with “Much
More”), avoiding contact with people (n=57, 60.0% responded with “Much More”), cooking at home (n=45,
46.9% responded with “More”), and communicating with others via phone or video (n=44 45.8%
responded with “More”). The personal habits that a majority of respondents reported “no change” in
frequency were the following: hair/nail grooming (n=69, 72.0%), household chores (n=58, 60.4%), regular
exercise (n=28, 29.2%), ordering takeout (n=30, 31.3%), alcohol consumption (n=53, 55.2%), recreational
drug use (n=85, 89.5%), nighttime sleep (n=43, 44.8%), and daytime sleep (n=53, 55.2%).
COVID-19 Knowledge
        All respondents agreed that “The symptoms of COVID-19 include: cough, shortness of breath,
fever, chills, muscle pain, sore throat, new loss of taste or smell”; 88 (91.7%) agreed that “SARS-CoV-2
RNA has been detected in upper and lower respiratory tract specimens, blood, and stool specimens”; 86
(89.6%) disagreed that “Patients who were diagnosed with COVID-19 are denitively known to be immune
to reinfection after they recover”; 68 (70.8%) agreed that “UV light and disinfectants (like bleach) are
effective at killing SARS-CoV-2 on non-porous surfaces”.
        Figure 1A shows the results of respondents when asked to choose their sources of reference
information regarding COVID-19 from a list of options. A total of 74 (77.1%) respondents reported that
they received information from school/hospital announcements; 70 (72.9%) received information from
academic journals; 69 (71.9%) received information from network/news media; 52 (54.2%) from medical
school curriculum; and 47 (49.0%) respondents chose that one of their sources for COVID-19 information
was social media (Figure 1A).
Effects of the COVID-19 Pandemic

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        A total of 86 (89.6%) respondents stated that they “followed the Florida stay-at-home mandate
to limit non-essential activities” and 79 (82.3%) agreed or strongly agreed that they felt that they are “safe
and prepared at home during the Stay-At-Home mandate”. Of the 96 student respondents, 67 (69.8%)
agreed or strongly agreed that “My feelings of social connectedness have declined during the COVID-19
pandemic” (Figure 1B), 90 (93.8%) agreed or strongly agreed that “The COVID-19 pandemic has impacted
my academic experience” (Figure 1C), and 54 (56.3%) agreed or strongly agreed that “My medical school
has done well at mitigating the negative effect of the COVID-19 pandemic on my education,
psychological well-being, and personal health,” with only 20 (20.8%) disagreeing with this statement
(Figure 1D).
Anxiety levels of medical students
As can be seen in Table 1, Median GAD-7 score was 5 (3.00-8.75), and the average was 6.28 (+/-4.87). A
total of 41 (42.7%) respondents were considered to have no anxiety, 34 (35.4%) were in the mild anxiety
category, 15 (15.6%) were in the moderate anxiety category, and 6 (6.25%) were considered to be
experiencing severe anxiety, according to their score. Higher relative instances of anxiety were noted in
older age groups compared to younger, although more participants would be needed to determine any
statistical correlation (Figure 1E). Similarly, respondents from NSU MD and UF displayed lower relative
rates of anxiety than respondents from FIU, FSU, NSU DO and UCF, but sample sizes were limited for each
of the latter (Figure 1F). Respondents were asked questions regarding what factors they considered to
increase and decrease their anxiety. The statement ranked to cause the greatest increase in anxiety for
respondents was “interruption of daily activities” with 71 (74.0%), followed by “Feeling others are not
following guidelines” (n=66, 68.8%).  A total of 81 (84.3%) respondents agreed that “communicating with
friends and family” decreased their anxiety levels, followed by “practicing relaxation activities (exercise,
meditation, prayer, arts & crafts, etc.)” with 67 (69.8%) (Table 1).
Table 1. Calculated GAD-7 scores for survey respondents, as well as self-reported factors contributing to
or detracting from respondent anxiety by GAD-7 Category, Severe, Moderate, Mild and None. Numbers of
respondents given with percentages in parentheses.

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GAD-7 Category
Severe Moderate Mild None
Overall 6 (6.3%) 15
(15.6%) 34
(35.4%) 41
(42.7%)
Factors that Increased Anxiety Severe Moderate Mild None
Direct exposure to someone with COVID-19 0 (0%) 3 (20%) 8
(23.5%) 4
(9.8%)
Feeling symptoms of COVID-19 2
(33.3%) 5 (33.3%) 5
(14.7%) 6
(14.6%)
Testing positive for COVID-19 0 (0%) 1 (6.67%) 0 (0%) 2
(4.9%)
Losing a loved one to COVID-19 1
(16.7%) 3 (20%) 4
(11.8%) 5
(12.2%)
Other physical health conditions 1
(16.7%) 3 (20%) 5
(14.7%) 4
(9.8%)
Mental health 4
(66.7%) 11
(73.3%) 18
(52.9%) 8
(19.5%)
Financial instability. 2
(33.3%) 5 (33.3%) 7
(20.6%) 5
(12.2%)
Family physical health 4
(66.7%) 5 (33.3%) 11
(32.4%) 13
(31.7%)
Family mental health 3 (50%) 8 (53.3%) 11
(32.4%) 6
(14.6%)
Economic downturn 2
(33.3%) 8 (53.3%) 10
(29.4%) 12
(29.3%)
Job insecurity 0 (0%) 3 (20%) 2 (5.9%) 5
(12.2%)
Interruption of daily activities 5
(83.3%) 13
(86.7%) 25
(73.5%) 28
(68.3%)
Feeling others are not following guidelines 6 (100%) 13
(86.7%) 23
(67.7%) 24
(58.5%)
News updates on COVID-19 3 (50%) 13
(86.7%) 14
(41.2%) 15
(36.6%)
Living alone 1
(16.6%) 6 (40%) 8
(23.5%) 5
(12.2%)
Living with family 1
(16.67%) 5
(33.33%) 8
(23.53%) 7
(17.1%)
Factors that Decreased Anxiety Severe Moderate Mild None

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Positive attitudes from your colleagues 3 (50%) 5 (33.3%) 13
(38.2%) 20
(48.8%)
Educating yourself on COVID-19 2
(33.3%) 6 (40%) 14
(41.2%) 20
(48.8%)
Practicing relaxation activities (exercise, meditation,
prayer, arts & crafts, etc.) 4
(66.7%) 10
(66.7%) 25
(73.5%) 28
(68.3%)
Communicating with friends & family 6 (100%) 14
(93.3%) 28
(82.4%) 33
(80.5%)
Avoiding exposure in public 6 (100%) 11
(73.3%) 24
(70.6%) 20
(48.8%)
Feeling others are following guidelines 3 (50%) 4 (26.7%) 10
(29.4%) 10
(24.4%)
Focusing on current personal affairs 2
(33.3%) 5 (33.3%) 15
(44.1%) 18
(43.9%)
Living alone 0 (0%) 0 (0%) 4
(11.8%) 4
(9.8%)
Living with family 1
(16.7%) 2 (13.3%) 12
(35.3%) 17
(41.5%)
Confounding Analysis
        The data was assessed for confounding variables that could have provided any signicant
difference in GAD-7 scores. After analysis, no differences were found related to gender (p=0.070), age
group (p=0.617), medical school (p=0.95), year in medical school (p=0.208), nor number of people
residing in household (p=0.605), regarding distribution of GAD-7 categorical scores.
Qualitative Analysis
        Free-response prompts were utilized to gain a more complete understanding of respondent
perceptions (Figure 2). The question regarding “what your school did well during the pandemic” had a
variety of answers, but the overarching themes included mental health services, faculty checking-in on
their students, and course directors being less stringent, such as moving classes to pass/fail grades
(Figure 2A). When asked how students perceived that the pandemic had affected their academic
experience, student respondents indicated that changes to online instruction with no in-person labs or
clinical experiences, along with delays of the clinical rotation schedule, and need for Step 1 examination
rescheduling, were the major factors impacting their academic experiences (Figure 2B). The majority of
students responded to the question, “Please describe what your school could have done better,” with
communication between administrators and students, lowering tuition fees since classes became virtual,
and awareness of the diculty of studying for board exams during a pandemic (Figure 2C). The question,
“Please describe any factors that made you feel underprepared or unsafe during the stay-at-home
mandate,” garnered answers involving house members traveling, nancial instability, and lack of

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emotional support. When students were asked to “Please describe what has affected your feeling of
social connectedness” they reported feelings of isolation with no roommates, not being able to go to
restaurants and bars, and use of electronic means of keeping in touch with others rather than being
together in-person.
Discussion
Conclusion and Implications
In the United States alone, deaths secondary to COVID-19 are estimated at 570,537 as of May 2021. The
COVID-19 pandemic is still having a signicant effect on the health, economic, environmental,
psychological, and social well-being of the world-wide population. It is the most challenging threat to
international public health in modern history and will likely impact daily life for the foreseeable future.
The information gathered from the survey data demonstrated that the COVID-19 pandemic also had a
measurable impact on medical students in the state of Florida. This study aimed to quantify and qualify
the effects of the COVID-19 pandemic on a cohort of medical students during the Florida stay-at-home
“lockdown” order. Florida medical student respondents were found to rely most on school and/or hospital
announcements, then academic journals, and then news media for information related to COVID-19
during the “lockdown” period, with a smaller portion of their information coming from medical school
curriculum or social media (Figure 1A). This indicates that the FL medical student respondents were more
likely to use more reputable informational resources than social media to stay informed about COVID-19,
as social media has been shown to carry more misinformation about COVID-19 and information seeking
on social media has been correlated with a lower ability to critically evaluate the validity of COVID-19
information [8,9]. Additionally, during the “lockdown” timeframe in FL (March to May), 69.8% of medical
student respondents reported agreeing or strongly agreeing that they experienced a decline in social
connectedness (Figure 1B), as is expected with the loss of in-person curricular activities, as well as limited
or fully virtual social interactions with classmates, friends, and family. Unsurprisingly, Florida medical
student respondents nearly unanimously agreed or strongly agreed (93.8%) that COVID-19 had impacted
their medical school experience with only 6.2% of respondents reporting neutral or no effect (Figure 1C).
Prior to the COVID-19 pandemic, the general incidence of anxiety amongst medical students was
measured to be 33.8% [6]. This study found 57.2% of respondents reported either mild, moderate, or
severe anxiety during the COVID-19 stay-at-home orders in FL.
       Analysis of response data indicated that a majority of student respondents had some level of
anxiety according to their GAD-7 scores, 55 out of 96 students (57.3%). Medical student age and medical
school size may provide inverse protective effects against student anxiety, but more data are needed to
form a denitive correlation (Figure 1E & F). Although the effects of the pandemic altering academic and
social experiences has contributed to this increase in anxiety across student populations, when
compounded with the baseline stress of medical school curriculum, it is evident that the COVID-19
pandemic affected medical student anxiety substantially[10-12]. Although 54 student respondents
(56.3%) agreed with the statement, “My medical school has done well at mitigating the negative effect of

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the COVID-19 pandemic on my education, psychological well-being, and personal health,” greater than
40% of students stated they disagreed or felt neutral regarding this statement (Figure 1D), indicating there
may be more that medical schools could do to improve conditions for their students. The common
positive theme identied by qualitative analysis was a transition of classes to pass/fail, and a negative
theme was the lack of adequate communication (Figure 2). Medical schools could focus on bolstering
these two aspects of student support in the future to ensure that students feel they are provided with
adequate assistance during challenging transitional periods.
       In a recent study documenting the effect of the COVID-19 pandemic on medical students in
Libya, a higher level of anxiety and depression (31.3%) was found among medical students during the
pandemic, as opposed to before (10.5%) [13]. Similarly, a study from Saudi Arabia measured an increase
in anxiety and feelings of emotional detachment from loved ones and peers [14]. In addition, a study from
the UK described a decrease in nal year medical students’ feelings of preparedness and condence as
they transitioned into the medical profession [15]. In Sao Paolo, Brazil, COVID-19 impacted medical
education at the pre-clerkship level as teachers struggled with technology and implementation of
videoconferences and interactive learning sessions, as well as keeping students engaged in discussion,
which led to a decrease in quantity and quality of lectures. Furthermore, students were anxious about
when and how they would be graded, and when they would make up in-person practical sessions. This
anxiety was compounded by the months of social isolation [16]. These ndings correlate with the results
of this study, indicating potential commonalities for medical students facing the pandemic on different
continents.
A proposed method to reduce medical students’ symptoms of anxiety and depression could be inclusion
of targeted community programs and communication practices. One such mechanism could potentially
be the introduction of a peer-mentorship through a social media platform pairing senior and junior
medical students. A recent study found that senior students, who were trained in learning methods,
communication skills, and effective consulting techniques were effective in providing wellness guidance
to junior students [17]. Senior students assisted by providing input such as stress relaxation techniques,
engaging in exercise, continuing online contact with family and friends, time management, and best
learning strategies for online learning. A post-intervention questionnaire found that 71% of junior medical
students believed the platform had a signicant impact on helping them adjust [17].
In planning for the future, a qualitative study aimed to develop a model for utilizing distance learning in
medical schools post-COVID used a 63-item assessment tool to evaluate faculty, student, social, and
logistic issues [18]. Overall, participants agreed that face-to-face instruction allowed for better student
inspiration, more meaningful personal connections, and better development of professionalism, cognitive,
communication and clinical skills. And while distance learning can be a successful learning modality for
many students, Ahmed and coworkers found that students with nancial challenges and special needs
may not have equal opportunities to access technology, thus the logistics for conducting distance
learning can be quite complicated [18].

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Study Limitations
       As the COVID-19 pandemic has progressed, there has been increasing evidence of disease
hotspots around the United States and other countries [19-22]. Since our study only sampled medical
students in the state of Florida, an understanding of the full effect that the COVID-19 pandemic had on
medical students in other locations can only be inferred. The exact nature of the pandemic effects on
medical students is likely dependent on local organization and government rules and regulations. How
severely specic communities were and continue to be impacted, and what response and support
measures medical schools provide to students will also play a role. However, the results of this study can
be used to generalize the effects that stressful events and hardships may have on medical students. This
study did not address factors related to local disease prevalence or differences in public perceptions of
COVID-19 to determine their impact on medical students. Another limitation of this study was that the
survey was distributed in June through August 2020. During this time, the FL stay-at-home orders had
been lifted, and restrictions on social interactions were being eased. This time-lag in data collection, after
the actual “lockdown” period, could have impacted the participants perspectives and responses.
Additionally, the relatively small sample size of this study (below 5% for most schools, except NSU MD at
16%) limited the results found. Additionally, students who were more anxious or who expressed greater
concern may have been more inclined to participate in the survey and share their opinions, thus
potentially skewing results compared to the whole FL medical student population.
Future Considerations
In the particularly vulnerable population of medical students – who are increasingly affected by stress,
nancial burden, and social isolation – medical schools might better provide support to their students by
working to build safeguards for their students in the event of future unexpected interruptions in
curriculum. These safeguards might include mentorship programs, availability mental health and
counseling resources, and designated open and frequent communications with students. Future studies
evaluating the effect of COVID-19 on medical students’ wellbeing and education outcomes at time points
post-pandemic will provide increasing insight regarding the COVID-19 pandemic’s full effects on medical
students.
Declarations
Funding
: This study was not nancially supported.
Conicts of interest/Competing interests
: The authors claim no conict of interest.
Availability of data and material
: Data will be made available upon request. Please email the
corresponding author at kcarneva@nova.edu.
Code availability
: Not applicable

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Authors’ Contributions:
S.B. and K.C. conceived the project idea. S.B. created the survey. S.B. and K.C.
submitted for IRB approval. W.W. performed the statistical calculations. All authors contributed to writing,
editing, and submitting the manuscript, and provided critical feedback to shape the research.
Ethics approval:
The study was revied by the Nova Southeastern University Institutional Review Board
and granted exemption #2020-292
Consent to participate and for publication:
Informed consent was obtained from each survey participant
and no identifying information was collected.
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Figures

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Figure 1
Medical student survey results: (A) percentage of respondents who used hospital/school announcements
(teal), academic journals (green), network/news media (red), medical school curriculum (orange), social
media (blue) or other (pink) information sources about the pandemic [total exceeds 100% as respondents
were able to select multiple sources]; (B) Respondent self-reported feelings of social connectedness
during the pandemic; (C) Respondent self-reported impact of the pandemic on their academic experience;

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(D) Respondent self-reported impression of their medical school’s response to mitigating the effects of
the pandemic; (E) Correlation of respondents’ age group and (F) respondents’ medical school aliation
with the respondent self-reported General Anxiety Disorder 7-item scale score category: none (blue), mild
(red), moderate (green), severe (yellow), numbers of respondents per category are given above each
column.
Figure 2
Pictorial representation of the qualitative free-responses to (A) what respondents believed their medical
schools did well, (B) the ways the pandemic impacted respondents’ medical education, (C) what
respondents perceived as areas where their medical schools could have done better. In each graphic,
created in WordCloud, the larger the word appears, the more frequently it occurred in the free responses.
Supplementary Files
This is a list of supplementary les associated with this preprint. Click to download.
SupplementalTableS1.docx