Impact of the Early Phase of the COVID-19 Pandemic on Medical Student Well-Being: a Multisite Survey

Abstract

Background: The COVID-19 pandemic drastically impacted medical student experiences. Little is known about the impact of the pandemic on student well-being and protective factors for burnout.

Objective: Assess US medical student burnout, stress, and loneliness during the initial phase of the pandemic, compare results to pre-pandemic data, and identify risk factors for distress and protective factors to inform support interventions.

Design: Cross-sectional survey of medical students conducted between May and July 2020.

Participants: 3826 students from 22 medical schools.

Main measures: Burnout (MBI-HSS), stress (PSS-10), loneliness (UCLA scale), and student experiences. Compared burnout and stress to pre-pandemic studies (2010-2020).

Key results: Of 12,389 students, 3826 responded (31%). Compared to pre-pandemic studies, burnout was lower (50% vs. 52%, P = 0.03) while mean stress was higher (18.9 vs. 16.0, P < 0.001). Half (1609/3247) reported high (≥ 6/9) loneliness scores. Significant differences were found in burnout and stress by class year (P = 0.002 and P < 0.001) and race (P = 0.004 and P < 0.001), with the highest levels in second- and third-year students and Black, Asian, or other racial minority students. Students experiencing financial strain or racism had higher burnout and stress (P < 0.001 for all). Respondents with COVID-19 diagnoses in themselves or family members had higher stress (P < 0.001). Nearly half (1756/3569) volunteered during the pandemic, with volunteers reporting lower burnout [48% (782/1639) vs. 52% (853/1656), P = 0.03].

Conclusions: While stress was higher compared to pre-pandemic data, burnout was significantly lower. Higher burnout and stress among Black, Asian, and other racial minority students and those who experienced financial strain, racism, or COVID-19 diagnoses likely reflect underlying racial and socioeconomic inequalities exacerbated by the pandemic and concurrent national racial injustice events. Volunteer engagement may be protective against burnout. Schools should proactively support vulnerable students during periods of stress.

Keywords: COVID-19 pandemic; burnout; medical student well-being; mental health; stress.

Figure 1

Burnout, stress, and loneliness among US medical student respondents with pandemic-related experiences. A Percentage of students who were burned out vs. student experiences (N = 3296). Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) which contains three subscales: emotional exhaustion (EE) (score range 0–54), depersonalization (DP) (score range 0–30), and personal accomplishment (PA) (score range 0–48). Those with high scores on the EE (≥ 27) and/or DP (≥ 10) subscales were considered to have burnout. Overall percent of all 3296 students who were burned out is included for reference. B Mean stress score vs. student experiences (N = 3250). Stress was measured using the 10-item Perceived Stress Scale (PSS-10), which has been used to assess stress in medical students. Total possible scores range from 0 to 40, with higher scores indicating higher levels of stress. The overall mean stress score for all 3250 students is included for reference. C Mean loneliness score vs. student experiences (N = 3247). Loneliness was measured using the 3-item University of California Los Angeles Loneliness Scale. Scores range from 3 to 9, with higher scores indicating greater loneliness. The overall mean loneliness score for all 3247 students is included for reference. * COVID-19 diagnosis in either the student or a family member, or having a loved one die from COVID-19. † P < 0.05.