# Medical School Curricular Changes and Their Impact on Mental Health during the Onset of the COVID-19 Pandemic

## TL;DR

This study explores how changes in medical school curricula during the early stages of the COVID-19 pandemic affected students' mental health.

## Contribution

The study identifies specific curricular adaptations and their associations with mental health outcomes during the pandemic's onset.

## Key findings

- Most medical schools shifted to virtual learning for basic science and core clerkships.
- Allowing in-person subinternships and core clerkships was linked to better mental health outcomes.
- Student relocation for coursework and region of study were associated with mental health impacts.

## Abstract

Objectives
 The main objectives were to identify and categorize the curricular changes that occurred in U.S. medical schools during the onset of the coronavirus disease 2019 (COVID-19) pandemic, and to identify the relationship between curricular changes and COVID-19 surges and student mental health.

Methods
 This Institutional Review Board-approved study consisted of a voluntary online survey of U.S. medical students. A convenience sample of students was reached through Facebook groups, medical student organizations, and administrators. The survey consisted of questions about demographics, curricular changes, and mental health. Univariate and backward stepwise multivariate linear regression were used to assess associations between mental health outcomes and demographic characteristics, curricular changes, and stressors.

Results
 Four-hundred and nine medical students completed the survey from 21 states between May 29, 2020, and August 29, 2020. Seventy-nine percent of respondents reported continuing their basic science curricula virtually. Forty-five percent reported that rotations continued virtually; those reported being offered virtually included internal medicine (77%), family medicine (78%), surgery (70%), obstetrics/gynecology (73%), pediatrics (74%), and psychiatry (76%). The majority of students reported that core clerkships (78%) and subinternships (86%) were not allowed, and away rotations were universally canceled. In univariate linear regression, having in-person subinternships and core clerkships allowed, as well as not relocating for coursework or residence (experienced by 35% of students), was associated with improved mental health outcomes, while experiencing graduation changes (15%) or being from the Southern region was associated with worse outcomes (
p
 < 0.001).

Conclusion
 During the early COVID-19 pandemic, students reported that their medical schools adapted by converting to virtual platforms for basic science and core clerkships. Allowing in-person rotations and limiting relocation were associated with improved mental health outcomes among students. Limitations included sample size, selection bias, and student perceptions.