# A Comparison of Pre- and Post-Clinical Simulation Anxiety Levels of Undergraduate Medical Students Before and During the COVID-19 Pandemic: A Prospective Cohort Study

## TL;DR

This study found that medical students experienced higher anxiety during clinical simulations in the pandemic compared to before and after vaccination.

## Contribution

The study compares anxiety levels during clinical simulations across three distinct pandemic-related time periods.

## Key findings

- Anxiety levels significantly increased during the pandemic compared to prepandemic and postvaccination periods.
- Simulations in biohazardous environments were linked to higher anxiety.
- No significant difference in anxiety was found between prepandemic and postvaccination periods.

## Abstract

The aim of the present study was to compare the anxiety of undergraduate medical students who were conducting clinical simulation (CS) prepandemic, during the pandemic, and postvaccination. The participants carried out an emergency simulation in a high-fidelity clinical skills laboratory. A prospective, simulation-based clinical cohort study of sixth-year undergraduate medical students was performed over three time periods: from 1 January to 15 April 2019; from 28 September to 18 December 2020; and from 11 May to 18 May 2022. The primary outcome was anxiety level (pre- and postsimulation) measured with the STAI test. Data on student demographics and baseline vital signs (before CS) were collected. A total of 373 students were ultimately included. A total of 40.2% of the cases were prepandemic (150 cases), 20.4% were pandemic (76 cases), and 39.4% were postvaccination (147 cases). The study period had a statistically significant effect on anxiety. There was a statistically significant increase in the incidence of anxiety during the pandemic time period compared with that during the prepandemic and postvaccination periods; no difference was found between the prepandemic and postvaccination periods. Performing CS in biohazardous environments significantly increases anxiety levels, so establishing mitigating measures to minimize the undesired effects of anxiety and promote the simulation-based learning process is necessary. The study was carried out at a single university; in future studies, it is necessary to carry out multicenter investigations to confirm the results.