Online-Learning due to COVID-19 Improved Mental Health Among Medical Students

Learner Success Model in Physical Therapy Education

BACKGROUND AND PURPOSE

Physical therapy educators recognize the need for enhanced learner support to ensure degree completion, licensure, and high-quality, safe patient care. High costs are associated with academic difficulty for learners, educators, programs, institutions, and clinical partners. The urgency to find effective learner support methods is paramount. This paper aims to explain the importance of the affective domain and to highlight external system-level factors affecting learner success through a proposed Learner Success Model in Physical Therapy Education (LSM PTE).

METHOD/MODEL DESCRIPTION AND EVALUATION

The LSM PTE captures the complexity of learner attributes and external systems. This model emphasizes the affective domain and interconnected systems in a socio-ecological model, placing learners within overlapping spheres of influence. The center represents internal attributes and essential learning domains while the spheres represent system-level factors also affecting outcomes. The model's application is explored through a case vignette for a learner needing additional support.

OUTCOMES

Although outcomes of the LSM PTE are not yet known, this model provides a framework for identifying potential impacts within each sphere.

DISCUSSION AND CONCLUSION

The LSM PTE illuminates a comprehensive perspective necessary to support learners in physical therapy education. This approach, which includes the affective domain and various system-level factors, extends beyond cognitive and psychomotor learning domains to promote successful learner outcomes, helping achieve program, profession, and societal goals.

The Role of Optimism and Self-Efficacy in the Relationship between Academic Stress and Depressive Symptoms in Medical Students Including the Use and Knowledge of Structural Health Promotion Offers

Background

In recent years, studies have highlighted that stress levels among medical students are alarmingly high. The study aim was to examine how academic stress and depressive symptoms in medical students are affected by individual moderators (self-efficacy/optimism) and structural influencing factors (health promotion offers).

Methods

Data collection occurred at three measurement points during the first 1.5 years at a medical school in Germany [baseline measurement (BM; Winter 2019, 226 participants), follow-up measurement 1 (FUM1; Summer 2020, 106 participants) and follow-up measurement 2 (FUM2; Winter 2020, 107 participants)]. Cross-sectional and longitudinal analyses were conducted with the data of FUM1 and FUM2, BM being only cross-sectionally analyzed as a baseline measurement. Interactions were calculated cross-sectionally with multiple linear regressions, and longitudinally with mixed effects models.

Results

Academic stress was positively correlated with depressive symptoms cross-sectionally. In the longitudinal sample, optimism was found to moderate the association between academic stress and depressive symptoms, while the moderating effect of self-efficacy was found cross-sectionally for FUM2. "University sports offers" was the most-used health promotion offer for both FUM1 and FUM2. The other services, especially "psychological counseling", were rarely used by the students. The prevalence of depressive symptoms increased during the study course (BM: 4.9%; FUM1: 25.5%; FUM2: 23.4%).

Conclusion

The increase of depressive symptoms linked to rising academic stress within the study course is alarming. Individual attributes such as optimism and self-efficacy have a moderating role on the relationship between academic stress and depressive symptoms and prevention offers may affect those individual attributes..

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02240-4.

Student mental health during Summer 2022 research experiences for undergraduates (REUs): Mentorship, remote engagement, and COVID-19

Objective: We examined how mentorship, remote participation, and COVID-19 challenges were associated with the mental health of college students participating in summer research programs. Participants: Participants were students participating in 78 National Science Foundation (NSF) Research Experiences for Undergraduate (REU) Sites during Summer 2022 (n = 516 students). Methods: We used multivariable generalized estimating equations that account for clustering by REU Site. Results: Students with more competent mentors had reduced depression severity. Students who spent ≥25% of their time doing remote research or ≥25% of their time in remote meetings and workshops had greater depression severity. Remote research was also associated with anxiety severity. Having a COVID-19 challenge that impacted students' research experience was associated with increases in depression and anxiety severity. Conclusions: Results suggest potential interventions: implement strategies to boost mentor competency and scaffold a support system into summer research programs to enhance student wellbeing. Additional research on remote engagement is needed.

Effects of the COVID-19 pandemic on the health of medical students transitioning from traditional education to distance learning: a prospective cohort

OBJECTIVE

To identify factors affecting the mental and physical health of first-year medical students during the period of rapid SARS-COV-2 spread in the COVID-19 pandemic to develop effective strategies for managing student well-being and education quality during global pandemics.

METHODS

656 first-year students of Sechenov University aged 17 to 23 years (17.91 ± 1.01 years) were included in an online anonymous survey. The study consisted of two assessment phases: in traditional training in September-December 2021 and in distance learning in January-March 2022. The State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, the Cantril Self-Anchoring Scale, and an original questionnaire were used for evaluation.

RESULTS AND DISCUSSION

During the rapid COVID-19 spread in COVID-19 pandemic, most first-year medical students had a high level of reactive anxiety, accompanied by depressive disorders and vegetative-somatic manifestations that significantly reduced their adaptive potential, life quality and academic performance. All first-year students regardless of age were shown to be sensitive to stressful situation. The females demonstrated more pronounced psycho-vegetative changes compared to the males. Students of medical, pediatrics and medico-preventive faculties reacted more strongly to the current situation than students of dental and pharmaceutical faculties. The identified changes in the psycho-vegetative student status were associated, first of all, with the difficult sanitary-epidemiological SARS-COV-2 situation and related financial problems. Students considered the transition to distance learning to be the most important support measures. Temporary transition to distance learning led to the significant decrease in the anxiety level, correction of depressive and vegetative manifestations, and significant increase in the life quality that was of great importance for the education quality. Significant student support measures during COVID-19 pandemic were also financial, psychological and informational assistance. The obtained results made it possible to develop the effective strategies for managing student health and education quality during global pandemics.

Academic self-efficacy: Associations with self-reported COVID-19 symptoms, mental health, and trust in universities' management of the pandemic-induced university lockdown

Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities' management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities' capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students' academic performance will be adversely affected.

Physical activity, weight management, and mental health during COVID-19 lockdown: A cross-sectional study of healthcare students in China

BACKGROUND

There is growing evidence that the social blockade brought about by the COVID-19 pandemic has dramatically affected college students' physical activity; however, their weight management behaviors and mental health have not been fully explored, especially among healthcare students. This study aimed to assess physical activity, weight management behaviors, and mental health among healthcare students during the campus lockdown and to analyze the factors influencing physical activity.

METHODS

A cross-sectional survey of 1,216 healthcare students from March 24, 2022, to April 11, 2022. To collect information about students' physical activity, weight management behaviors, and mental health, they were asked to complete the Physical Activity Questionnaire-Short Form (IPAQ-SF), 11 issues related to weight management behavior, and the World Health Organization 5-Item Well-Being Index (WHO-5) questionnaire. Binary logistic regression was performed to determine the factors influencing physical activity.

RESULTS

Almost half of the participants had low levels of physical activity (45%), the mean score for weight management behavior was 39.55±6.26, and 54.6% had low levels of well-being. Healthcare students without exercise habits during the non-epidemic period reported lower levels of physical activity (OR = 1.81; 95%CI = 1.41-2.34, P<0.001). Participants with poor weight management behavior were more likely than other participants to report lower levels of physical activity (OR = 0.92; 95%CI = 0.90-0.94, P < 0.001). Likewise, the odds of being physically inactive were higher among the happier participants (OR = 0.98; 95%CI = 0.96-0.99, P = 0.031).

CONCLUSIONS

During the COVID-19 lockdown, most healthcare students in Gansu province lack physical exercise and have a low health level. Significant correlation factors for low physical activity levels were grade level, non-lockout exercise habits, weight management level, and well-being. These findings demonstrate the importance of developing targeted policies and programs encouraging physical activity among medical students.

Online learning predictors of mental health in third-level students during the COVID-19 pandemic in Ireland

Objective COVID-19 forced third-level students to transition to online learning (OL). Many students encountered issues with OL, such as accessibility. However, the relationship between OL issues and mental health during this time remains poorly understood. Participants: Third-level students in Ireland (N = 268) completed an online questionnaire examining experiences with OL and mental health during COVID-19. Methods: OL social, lecturer, accessibility, individual skills, and environment issues, were entered into logistic regression analyses to examine whether these variables predicted mental health outcomes and/or preference to keep OL. Results: Students reporting more individual skills issues were more likely to attain a probable diagnosis of posttraumatic stress disorder, complex posttraumatic stress disorder, and depression (p < 0.0083); students who reported more environment issues were less likely to report preference to keep OL (p < 0.0005). Conclusions: Given individual skills issues associated with worse mental health, future research should examine improving student perceptions of their own OL skills.

Mental health and academic performance of college students: Knowledge in the field of mental health, self-control, and learning in college

The aim of this research is to analyze the impact of mental health on the academic performance of junior and senior students studying in a university setting during the 2022-2023 academic year, in the post-COVID period. The study was conducted in Beijing, China, with the participation of 600 students, including 300 first-year students and 300 fifth-year students. DASS (Depression, Anxiety, and Stress Scale) and PHQ-9 (Patient Health Questionnaire-9) questionnaires were employed to measure mental health. The DASS assesses symptoms of depression, anxiety, and stress, while the PHQ-9 specifically evaluates depression severity. Academic performance was evaluated using a 12-point scale, which incorporated various criteria such as exam scores, coursework performance, and participation in extracurricular activities. The research was conducted across five faculties of the university from 2022 to 2023. In the study, fifth-year students demonstrated a higher level of mental health compared to first-year students, with an average DASS score of 27.1 and 24.2, respectively. Interestingly, despite this, first-year students achieved higher academic performance indicators, with an average score of 8.2 compared to 9.8 in fifth-year students. Correlation analysis revealed significant associations between stress, depression, and anxiety levels with academic performance (stress: r = -0.25, p < 0.001; depression: r = -0.20, p = 0.003; anxiety: r = -0.18, p = 0.008). These findings highlight the critical importance of addressing students' mental well-being, particularly in later academic years. Recommendations include implementing support programs and developing online resources for students.

Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

As future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.

METHODS

We systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg's and Egger's tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.

RESULTS

We identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%-49%) and 48% (95% CI, 43%-52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%-32%) and 30% (95% CI, 26%-35%), respectively. There was high heterogeneity between studies, with I2 ranging from 99.58%-99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.

CONCLUSIONS

We demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

A public health view and comparison between online and on-campus learning to evaluate sleep and mental health among undergraduate students

Background

The COVID-19 pandemic changed people's lives. The majority had to adapt to working online including students. The shift to online learning caused serious sleep and mental health issues among students. This study aimed to examine the variations between the prevalence of sleep and mental health problems among undergraduate students during the periods of online learning and on-campus learning.

Method

An online survey was distributed to medical students in Saudi Arabia.

Results

A total of 110 participated in the study (age = 21 ± 1.4 years). The on-campus anxiety (8.2 ± 6.3) was significantly higher than online anxiety (5.5 ± 5.1). On-campus daytime sleepiness (8.5 ± 4) was significantly higher when compared to online daytime sleepiness (6.7 ± 4.6). Although not significant, the on-campus stress (7.7 ± 5.7) and insomnia (12 ± 7.3) were higher than online stress (6.9 ± 5.5) and insomnia (11.5 ± 6). The online depression (6.6 ± 5.7) was higher than the mean on-campus depression (5.8 ± 5.4). A significant strong positive correlation was found between on-campus anxiety and on-campus stress. A significant moderate positive correlation was detected between on-campus anxiety and on-campus daytime sleepiness. A weak but significant correlation was found between on-campus anxiety and on-campus insomnia. On-campus anxiety was significantly predicted by the following model, which included on-campus stress, insomnia, and daytime sleepiness (P < .001).

Conclusion

Medical students reported lower anxiety, daytime sleepiness, stress, and insomnia during their online learning compared to on-campus learning. Only depression was higher during online learning compared to on-campus learning.

Impact of COVID-19 on Academic Burnout among Medical College Students in China: Findings from a Web-Based Survey

BACKGROUND Academic burnout can affect students' academic behavior and performance and especially damages the careers of medical college students. Medical education systems during the COVID-19 pandemic have met unprecedented challenges that have influenced medical students. This study aimed to explore the effects of psychological resilience, stress, and smartphone addiction on academic burnout among Chinese medical students. MATERIAL AND METHODS This study utilized a cross-sectional design, from March 13, 2022 to March 31, 2022, within the Wannan Medical College, where students completed a web-based survey. The Chinese version of the Academic Burnout Scale (ABS), the 10-item Smartphone Addiction Scale-Short Version (SAS-SV), the Connor-Davidson Resilience Scale (CD-RISC 10) and the Perceived Stress Scale (PSS-4) were used in this survey. Data entry and analysis were conducted using IBM SPSS ver. 22.0. Pearson's correlation coefficient (r) was used to examine the correlations between medical college students' academic burnout and smartphone addiction and mental health. Binary logistic regression analysis was carried out to evaluate the factors influencing academic burnout. RESULTS Of 3190 medical college students who completed the survey, 1521 (47.7%) had some degree of academic burnout. Gender, being a student leader, grades, perceived stress, and smartphone addiction were associated with the total score of academic burnout. Psychological resilience and adapting to online classes were protective factors against academic burnout. CONCLUSIONS Academic burnout is common among medical college students in China after the COVID-19 pandemic, and it is urgent to address this situation to improve the quality of medical education.

Relationship between depression, anxiety, stress and smartphone addiction in COVID-19 nursing students

OBJECTIVE

to verify the relationship between symptoms of depression, anxiety, stress and smartphone addiction in COVID-19 nursing students.

METHOD

this was a descriptive-analytical study of 206 nursing students. A sociodemographic characterization and smartphone use instrument adapted from the literature and the following scales Depression, Anxiety and Stress Scale and Smartphone Addiction Inventory were used for data collection. Sociodemographic data and smartphone use were analyzed using descriptive statistics and the relationship between symptoms of depression, anxiety, stress and smartphone addiction was analyzed using multiple logistic regression.

RESULTS

the prevalence of smartphone addiction among nursing students was 129 (62.6%) and there was a relationship between symptoms of moderate depression (p=0.049), severe/very severe depression (p=0.005) and mild anxiety (p=0.028) and severe/very severe anxiety (p=0.019) and smartphone addiction.

CONCLUSION

the data show that the construction and implementation of smartphone use policies in the academic and hospital context to prevent smartphone addiction and control associated risk factors is necessary.

BACKGROUND

(1) High prevalence of smartphone addiction among nursing students. (2) There was a relationship between symptoms of depression, anxiety and smartphone addiction. (3) Nursing has a leading role in identifying and managing addictions. (4) A multidisciplinary approach to the prevention and management of smartphone addiction. (5) Smartphone addiction in nursing students is a new issue in Brazil.

Mental Health Disparities among Pre-Clinical Medical Students at Saint Louis University during the COVID-19 Pandemic

The COVID-19 pandemic disproportionately affected racial and ethnic minorities. Medical students were also particularly impacted as they coped with increased stressors due to delayed medical training and a high prevalence of mental health conditions. This study investigates mental health disparities of underrepresented in medicine (URM) students at the Saint Louis University School of Medicine (SLUSOM). An anonymous online survey was distributed to first- and second-year medical students at SLUSOM in February 2021. The survey queried demographic information, lifestyle factors, and pandemic-related and institutional concerns. Mental health was assessed via the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Statistical tests were run with SPSS, version 27. A convenience sample of 87 students responded to the survey. Students who were categorized as URM were significantly more likely to be at risk of major depressive disorder during the pandemic. Concern about a lack of financial support was significantly greater among students categorized as URM. Concerns regarding a lack of financial support, mental health support, and decreased quality of medical training significantly predicted PHQ-9 scores. Our findings revealed several key factors that may exacerbate mental health disparities among URM students during the pandemic. Providing adequate financial and academic resources for URMs may improve mental health outcomes for similar adverse events in the future.

Beyond COVID-19: the impact of recent pandemics on medical students and their education: a scoping review

INTRODUCTION

Over the past two years, coronavirus disease (COVID-19) has greatly altered medical student education as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality medical education. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared medical educators for COVID-19? This scoping review investigated the educational and personal impact of recent pandemics on medical students.

METHODS

This review followed the PRISMA-ScR guidelines for scoping reviews. Nine databases including PubMed, ERIC, and EMBASE were systematically searched using keywords and subject headings related to medical students and SARS, H1N1, MERS, Ebola, Zika, and COVID-19. Studies were limited to research studies published between 2000 and 2020 and in English. Based on exclusion and inclusion criteria, all studies were independently screened by two reviewers first by the title/abstract and then via full text. Data were extracted from the included studies and analyzed qualitatively using thematic analysis.

RESULTS

A total of 174 studies fit the criteria. Seven major themes emerged from those studies: educational adaptations and online modifications, knowledge and attitudes of students, mental wellness of students, student involvement and use of telehealth, student vaccination, physical wellness of students, and stigma.

CONCLUSION

This review provided insights into how medical students were affected by recent pandemics and their perceptions of pivoting to online education, mental health, and knowledge of the diseases. Additionally, this review showcases the various educational adaptations that emerged uniquely during the COVID-19 pandemic, such as telehealth services or video conferencing tools, that can be utilized in a post-pandemic environment.

The mental health impact of the COVID-19 pandemic on post-secondary students: A longitudinal study

This prospective longitudinal study measured sex-specific changes in depression, anxiety, and stress scores using, validated Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Perceived Stress Scale (PSS) in a cohort of 1445 post-secondary students (500 males, 945 females) assessed at three time points from December 2020 to January 2022. Participants were ascertained from a population of 15,585 students with in-person activities on campus at baseline and recruited from December 2020 to January 2021. We also assessed how sociodemographic characteristics influenced students' mental health outcomes. Inverse probability weighting was used to account for missing data and attrition. Linear mixed effects models were used to analyze the relationship between the mental health scores in each questionnaire, demographic and academic data, and public health stringency measured by the local stringency index. No change was observed in questionnaire scores over time for males and females, but the stringency index was significantly associated with increased stress. Being in a non-health-related-field or being white affected males and females differently for stress and anxiety, but not depression. Demographics tended to be more influential on females' mental health than males. In conclusion, mental health resource allocation in time of emerging pandemic could benefit from targeted interventions.

The COVID-19 pandemic and mental health in Kazakhstan

The COVID-19 pandemic had significant impacts on mental health. We examined factors associated with symptoms of depression and anxiety during the COVID-19 pandemic in Kazakhstan. We surveyed 991 adults in Kazakhstan in July 2021 using multistage stratified sampling. Depression and anxiety were measured with the Patient Health Questionnaire-4. We conducted logistic regression to assess associations between depression and anxiety and sociobehavioral factors. Overall, 12.01% reported depressive symptoms and 8.38% anxiety. Higher likelihood of depression was associated with being female (AOR: 1.64; 95% CI [1.05, 2.55]), having experience with COVID-19 in the social environment (AOR: 1.85; 95% CI [1.1-3.14]), experiencing food insecurity (AOR: 1.80; 95% CI [1.11-2.89]), increased family conflict (AOR: 2.43; 95% CI [1.32-4.48]) and impaired healthcare access (AOR: 2.41; 95% CI [1.32-4.41]). Higher likelihood of anxiety was associated with being female (AOR: 3.43; 95% CI [1.91-6.15]), increased family conflict (AOR: 2.22; 95% CI [1.11-4.44]) and impaired healthcare access (AOR: 2.63; 95% CI [1.36-5.12]). Multiple factors were associated with mental health in Kazakhstan during the COVID-19 pandemic. Further research is needed to determine the extent to which these factors and their associated mental health outcomes may persist.

Sociodemographic and educational factors associated with mental health disorders in medical students of clinical years: A multicenter study in Peru

OBJECTIVE

To identify sociodemographic and educational factors associated with mental health disorders in Peruvian medical students in clinical years.

METHODS

Cross-sectional study. We surveyed students from 24 Peruvian medical schools. We defined negative perception of educational environment as having a Dundee Ready Educational Environment Measure score below 100 points; we defined anxiety and depression as having more than 4 points on the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scales, respectively. Poisson regression with robust variance was used to assess the association between negative perception of educational environment and mental health alterations.

RESULTS

Among the 808 participants, the prevalence of anxiety and depression symptoms was 77.6% and 67.3%, respectively. Negative perception of the educational environment was 31.6%. The factors associated with anxiety were being male (PR = 0.95, 95% CI:0.91-0.98), previous medical condition (Prevalence ratios PR = 1.10, 95% CI:1.05-1.16), previous diagnosis of coronavirus disease 2019 (PR = 0.93, 95% CI: 0.93-0.94), being from highlands (PR = 1.11, 95% CI: 1.05-1.16), studying at a national university (PR = 0.90, 95% CI: 0.88-0.92), and negative perception of the educational environment (PR = 1.04, 95% CI: 1.03-1.05), while factors associated with depression were being male (PR = 0.94, 95% CI: 0.93-0.95), previous medical condition (PR = 1.12, 95% CI: 1.08-1.17), type of university (national) (PR = 0.95, 95% CI: 0.95-0.96), and negative perception of the educational environment (PR = 1.11, 95% CI: 1.07-1.16).

CONCLUSION

We found evidence that during the COVID-19 pandemic anxiety and depression are prevalent among Peruvian medical students. Sociodemographic factors and negative perception of educational environment were associated with the presence of these conditions.

Student stress and mental health during online learning: Potential for post-COVID-19 school curriculum development

This article aims to analyze the trend of publications on student stress and mental health topics during online learning as well as the potential for post-COVID-19 curriculum development. 1456 articles were analyzed by the bibliometric method. Data were obtained from the Scopus database consisting of 1382 articles, 73 review articles, 1 conference article. Based on the analysis, Li X is the most productive author with 16 documents, while in terms of the number of citations, Wang C ranks first with 3897 citations. Meanwhile the most frequently used keywords were COVID-19 (n = 862), followed by stress (n = 312), mental health (n = 260), anxiety (n = 248), and depression (n = 214). These represent the trend of publications related to the topics discussed in 2020. Moreover, alternative research themes such as online learning, higher education, sleep, loneliness, perceived stress, insomnia, emotional intelligence, and psychological resilience can be further investigated in the future. This article recommends developing a curriculum that can accommodate various issues during COVID-19 and the changing learning climate after the pandemic. The potential for post-COVID-19 school curriculum development is also discussed.

Status of mental health among college and university students during first and second wave of COVID-19 outbreak in India: A cross-sectional study

Background

India has been badly affected by Covid-19 not only in terms of human lives but also has a long-term effect on mental health of the population. This paper is an attempt to understand the psychological effects of the pandemic on the college and university students in India after the second wave of COVID-19 outbreak and its associated factors.

Method

A web-based survey was conducted to collect information from the students both at individual and household level. The study applied binary and multivariate logistic regression to estimate the adjusted and unadjusted marginal effects of the predictor variables.

Result

Results show a significant increase in mental health concerns during the second wave of the pandemic, as compared to the first year. The key factors contributing to the higher prevalence of depression, anxiety, and stress are the difficulties faced in the adaptation to the new way of learning, fear of discontinuation of education due to financial constraints faced by household, limited physical interaction, and prolonged screen-time during the pandemic.

Limitation

The study has some limitations regarding selection of the sample as the survey was web-based. Also, the mental health situation of the students is self-reported and the study does not consider the prevailing mental health issues before the pandemic.

Conclusion

The study recommends initiatives like offering counselling classes and strategies to cope up with mental health disorders. Further, there is a need to conduct follow-up studies to assess the long-term impacts of prolonged home quarantine on the mental health of the students.

The impact of COVID-19 on online medical education: a knowledge graph analysis based on co-term analysis

BACKGROUND

This study aims to identify the characteristics and future directions of online medical education in the context of the novel coronavirus outbreak new through visual analytics using CiteSpace and VOSviewer bibliometric methods.

METHOD

From Web of Science, we searched for articles published between 2020 and 2022 using the terms online education, medical education and COVID-19, ended up with 2555 eligible papers, and the articles published between 2010 and 2019 using the terms online education, medical education and COVID-19, and we ended up with 4313 eligible papers.

RESULTS

Before the COVID-19 outbreak, Medical students and care were the most frequent keywords and the most cited author was BRENT THOMA with 18 times. The United States is the country with the greatest involvement and research impact in the field of online medical education. The most cited journal is ACAD MED with 1326 citations. After the COVID-19 outbreak, a surge in the number of research results in related fields, and ANXIETY and four secondary keywords were identified. In addition, the concentration of authors of these publications in the USA and China is a strong indication that local epidemics and communication technologies have influenced the development of online medical education research. Regarding the centrality of research institutions, the most influential co-author network is Harvard Medical School in the United States; and regarding the centrality of references, the most representative journal to which it belongs is VACCINE.

CONCLUSION

This study found that hey information such as keywords, major institutions and authors, and countries differ in the papers before and after the COVID-19 outbreak. The novel coronavirus outbreak had a significant impact on the online education aspect. For non-medical and medical students, the pandemic has led to home isolation, making it difficult to offer face-to-face classes such as laboratory operations. Students have lost urgency and control over the specifics of face-to-face instruction, which has reduced the quality of teaching. Therefore, we should improve our education model according to the actual situation to ensure the quality of teaching while taking into account the physical and psychological health of students.

Questions of Well-Being and Inclusion in Online Undergraduate Medical Education During COVID-19: A 2-Phased Focused Scoping Review

PURPOSE

Undergraduate medical education (UGME) was transformed by the rapid move to online curriculum delivery during the COVID-19 pandemic. Most research on online UGME has focused on measuring its effectiveness. However, medical educators also require evidence regarding its implications with respect to well-being and inclusion.

METHOD

To explore online learning transition, particularly the effect on well-being and inclusion, this 2-phased focused scoping review employed a revised Joanna Briggs Institute approach: (1) developing review questions and objectives; (2) determining eligibility criteria; (3) developing the search strategy; (4) extracting, analyzing, and discussing findings; (5) drawing conclusions; and (6) discussing implications for practice and further research.

RESULTS

The review ultimately included 217 articles, of which 107 (49%) explored student and staff well-being during online UGME, 64 (30%) focused on inclusion in this context, and 46 (21%) examined both well-being and inclusion. Additionally, 137 of included articles (63%) were research/evaluation, 48 (22%) were descriptive, and 32 (15%) were opinion. Of the 137 research/evaluation studies, 115 (84%) were quantitative, 10 (7%) were qualitative, 8 (6%) were mixed methods, and 4 (3%) were Reviews. Among these research/evaluation studies, the most commonly used data collection method was surveys (n = 120), followed by academic tests (n = 14). Other methods included interviews (n = 6), focus groups (n = 4), written reflections (n = 3), user data (n = 1), and blood tests (n = 1).

CONCLUSIONS

Important questions remain regarding the safety and inclusiveness of online learning spaces and approaches, particularly for members of historically excluded groups and learners in low-resource settings. More rigorous, theoretically informed research in online medical education is required to better understand the social implications of online medical education, including more in-depth, qualitative investigations about well-being and inclusion and more strategies for ensuring online spaces are safe, inclusive, and supportive.

The Switch to Online Learning during the COVID-19 Pandemic: The Interplay between Personality and Mental Health on University Students

The switching from traditional to online learning during the COVID-19 pandemic was challenging for students, determining an increase in physical and mental health problems. The current paper applied a two-step cluster analysis in a large sample of n = 1028 university students (Mage = 21.10 years, SD = 2.45 years; range: 18-30 years; 78.4% females). Participants responded to an online survey exploring neuroticism, trait/state anxiety, general self-efficacy, academic motivation, fear of COVID-19, the impact of the COVID-19 pandemic on physical and mental health, and the help requests. Results showed two significant clusters of students having a Maladaptive Academic Profile (n = 456; 44.4%) or an Adaptive Academic Profile (n = 572; 55.6%). Significant differences were found between the two clusters, where students belonging to the Maladaptive Academic Profile reported higher levels of neuroticism, higher dispositional and situational anxiety, and fear of COVID-19, and lower self-efficacy and academic motivation than students of the Adaptive Academic Profile cluster. In addition, more physical or mental health problems and help requests, mainly to partners during the COVID-19 pandemic, were found in the Maladaptive Academic Profile cluster compared to the Adaptive Academic Profile. Finally, the practical implications of the study's results in implementing university counseling services as protective measures to contrast psychological distress in the long-term COVID-19 pandemic are discussed.

Is Satisfaction with Online Learning Related to Depression, Anxiety, and Insomnia Symptoms? A Cross-Sectional Study on Medical Undergraduates in Romania

The objective of this study was to investigate online learning satisfaction in a sample of university students and its relationship with depression, anxiety, insomnia, and the average number of hours spent online. A total of 463 medical students were recruited for an online survey conducted from February to March 2022 with the main objective of estimating online learning satisfaction, while secondary outcomes involved assessing the relationship between online learning and depression, anxiety, insomnia, and the average number of hours spent online. A total of 285 participants were female (71.4%) and the mean age was 20.2 years. The results revealed that depression, anxiety, and insomnia are negatively correlated with overall satisfaction with e-learning. The more time students spent online, the greater the overall satisfaction. There are significant differences regarding student perceptions of interactivity in online learning satisfaction outcomes (p < 0.05, η2 partial Eta Squared-0.284). The opportunity to learn via chat-box presented differences in overall satisfaction while pleasant aspects of online learning, such as “no travel” and “economy”, were related to satisfaction. The students revealed that the higher the psychopathology scores, the less satisfied they were with online learning, while a higher number of hours spent online contributed positively to satisfaction.

Relationship between Anxiety, Depression and Learning Burnout of Nursing Undergraduates after the COVID-19 Epidemic: The Mediating Role of Academic Self-Efficacy

BACKGROUND

Although cross-sectional studies on the learning status of nursing undergraduates during the COVID-19 epidemic have surged, few studies have explored the normalization of COVID-19 on students' learning burnout and mental health. The study was designed to investigate the learning burnout of nursing undergraduates in school under the normalization of the COVID-19 epidemic and explore the hypothesized mediation effect of academic self-efficacy in the relationship between anxiety, depression and learning burnout in Chinese nursing undergraduates.

METHODS

A cross-sectional study was conducted among nursing undergraduates in the school of nursing of a university in Jiangsu Province, China (n = 227). A general information questionnaire, College Students' Learning Burnout Questionnaire, Generalized Anxiety Disorder Scale (GAD-7), and Patient Health Questionnaire depression scale (PHQ-9) were administered. Descriptive statistical analysis, Pearson correlation analysis, and multiple linear regression analysis were performed via SPSS 26.0. Process plug-in (Model 4) was used to test the mediating effect of academic self-efficacy (bootstrap 5000 iterations, α = 0.05).

RESULTS

Learning burnout (54.1 ± 0.656) was positively correlated with anxiety (4.6 ± 0.283) and depression (5.3 ± 0.366) (p < 0.01) and was negatively correlated with academic self-efficacy (74.41 ± 0.674) (p < 0.01). Academic self-efficacy plays a mediating role between anxiety and learning burnout (0.395/0.493, 80.12%) and a mediating role between depression and learning burnout (0.332/0.503, 66.00%).

CONCLUSION

Academic self-efficacy has a significant predictive effect on learning burnout. Schools and teachers should strengthen the screening and counselling of students' psychological problems, detect learning burnout caused by emotional problems in advance and improve students' initiative and enthusiasm for learning.

The impact of the COVID-19 pandemic on undergraduate and postgraduate students: A cross-sectional survey

Background

The COVID-19 pandemic has impacted many facets of life. This study focuses on undergraduate and postgraduate students in China to explore how the pandemic has affected health status, daily life, learning situations, graduation-related situations, and their studies or work planning.

Methods

This study sent online questionnaires to 2,395 participants to investigate the extent to which they were affected by the epidemic in the various aspects mentioned above and to understand what help they tend to get in the face of these effects.

Results

A total of 2,000 valid questionnaires were collected. The physical health of 82.90% of the respondents was affected to varying degrees, with male students, non-medical students, and graduates being more affected than female students, students with medical majors, and non-graduates, respectively. The proportion of students affected by mental health, the total amount of physical exercise, emotional life, and interpersonal communication was 86.35, 88.65, 80.15, and 90.15%, respectively. Compared with medical students and non-graduates, non-medical students and graduates were more affected. In addition, students' learning and graduation conditions have also been affected to a certain extent: 13.07% of students may not be able to graduate on time, and the proportion of postgraduate students' graduations affected was higher than that of undergraduate students.

Conclusion

The COVID-19 pandemic has affected the health status of students, their daily lives, learning situations, and so on to varying degrees. We need to pay attention to the issues, provide practical solutions, and provide a basis for better responses to similar epidemics in the future.

The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

This meta-analysis and systematic review aimed to evaluate the global prevalence and risk factors of mental problems (i.e., depression, anxiety, stress, sleep disorder, posttraumatic stress disorder (PTSD), burnout, psychological distress, and suicidal ideation) among medical students during the COVID-19 pandemic.

METHOD

We searched PubMed, Embase, Web of Science, psycARTICLES, PsycINFO, CNKI, and Wan Fang for studies on the prevalence of mental problems among medical students from January 1, 2020, to April 1, 2022. The pooled prevalence was calculated by random-effect models. We performed a narrative review to identify the risk factors.

RESULTS

The meta-analysis included 201 studies (N = 198,000). The prevalence of depression (41 %, 95 % CI, 37-45 %,), anxiety (38 %,95 % CI, 34 %-42 %), stress (34 %, 95 % CI, 27 %-42 %), sleep disorder (52 %, 95 % CI, 44 %-60 %), psychological distress (58 %, 95 % CI, 51 %-65 %), PTSD (34 %, 95 % CI, 22 %-46 %), suicidal ideation (15 %, 95 % CI, 11 %-18 %) and burnout (38 %, 95 % CI, 25 %-50 %) was high. The major risk factors were being female, being junior or preclinical students, exposure to COVID-19, academic stress, psychiatric or physical disorders history, economic trouble, fear of education impairment, online learning trouble, fear of infection, loneliness, low physical activity, low social support, problematic internet or smartphone use, and young age.

LIMITATIONS

Most studies were cross-sectional. Few studies provided a reasonable response rate, suggesting potential selection bias.

CONCLUSIONS

The study demonstrated a high prevalence and risk factors for mental problems during COVID-19, calling for mental health services. Our findings are valuable for college and health authorities to identify high-risk students and provide targeted intervention.

Patterns in Mental Health Symptomatology and Cigarette, E-cigarette, and Marijuana Use Among Texas Youth and Young Adults Amid the Coronavirus Disease 2019 Pandemic

INTRODUCTION

This study examined patterns in mental health symptomatology and smoking and vaping behaviors among youth and young adults over a 1-year period from before to during the first year of the Coronavirus Disease 2019 (COVID-19) pandemic.

AIMS AND METHODS

Participants (n = 2148) were 16-24-year-olds who completed three waves of the Texas Adolescent Tobacco and Marketing Surveillance Study (TATAMS). Descriptive statistics and mixed effects logistic regression models were used to examine changes in anxiety symptoms, depressive symptoms, perceived stress, and cigarette, e-cigarette, and marijuana use from before COVID-19 (fall 2019) to 6-month follow-up (spring 2020) and 12-month follow-up (fall 2020) periods during COVID-19. Longitudinal associations between mental health symptomatology and smoking and vaping were examined.

RESULTS

Modest increases in symptoms of anxiety and depression were observed from before to during COVID-19. Perceived stress remained high and unchanged. Ever marijuana use increased at 6- and 12-month follow-up, while ever cigarette and e-cigarette use increased significantly only at 12-month follow-up. Marijuana use frequency increased significantly at 6- and 12-month follow-ups. Adjusting for sociodemographic factors, increased symptoms of anxiety and depression predicted increases in ever cigarette, e-cigarette, and marijuana use, and past 30-day cigarette and e-cigarette use, but not past 30-day marijuana use. Higher perceived stress predicted increases in ever use of cigarettes and e-cigarettes and past 30-day cigarette use.

CONCLUSIONS

Changes in mental health symptomatology and smoking and vaping behaviors among young people in Texas varied during this period of the COVID era. Increases in mental health symptomatology predicted increases in cigarette, e-cigarette, and marijuana use behaviors.

IMPLICATIONS

This study adds to the limited research on the longitudinal impact of anxiety symptoms, depressive symptoms, and perceived stress on cigarette, e-cigarette, and marijuana use from before to during the first year of the COVID-19 pandemic. Findings warrant health messaging and interventions that address the significant impact of worse mental health on increased smoking and vaping behavior, especially during crises like COVID-19 that may exacerbate mental health and substance use behaviors.

Experience of COVID-19 disease and fear of the SARS-CoV-2 virus among Polish students

Background

The SARS-CoV-2 virus pandemic has significantly affected individuals and entire societies. It has caused a number of adverse consequences for public health. It has contributed to lower average life expectancy and significantly reduced the sense of health security. It has affected not only physical but also mental health. COVID-19 infections have become so common in many countries, including Poland, that almost every member of society has either experienced it themselves or has a family member or friend who have been affected by the disease. The investigations undertaken in the article concern the fear of COVID-19 infection among Polish university students, determined by the experience of the disease -whether direct or among loved ones.

Methods

An online survey was conducted with 851 students. It took place between 1 and 15 March 2021, a year after detection of the first case of infection with the virus in Poland. The aim of the study was to find out about the relationship between the experience of COVID-19 disease (whether direct or among people close to the respondent) and fear of this disease among university students in Poland. The analysis used intergroup comparison tests (Mann-Whitney U Test and t-test).

Results

The results indicate that the level of fear of COVID-19 among Polish university students was low (M = 1.98; SD = .49), with women (M = 2.04; SD = .75) presenting statistically higher (t (620.46) = 3.05; p = .002) fear than men (M = 1.87; SD = .74). The situation of the respondent having had a close person fall ill with COVID-19 or die as a result of coronavirus infection was found to be significant for the level of experienced fear of COVID-19 in the studied group (t (469.46) = -2.98; p = .003).

Conclusions

The significantly higher level of fear in the group of young people who knew someone close with severe (fatal) COVID-19 disease indicates that psychological support may be more significant for such people than for individuals who have not experienced such a situation. A similar conclusion can be formulated taking into account the gender criterion, as the results make it possible to predict that women expect more support in a pandemic situation.

Psychological well-being amongst students in a Malaysian medical college one year into the COVID-19 pandemic: a cross-sectional study

Background

The frequent disruption to the delivery of education and the switch to online learning amidst the COVID-19 pandemic affected students’ mental health. The objectives of the study were to explore the levels of anxiety, depression, somatic symptoms, and stress among students during the COVID-19 pandemic and their associations with sociodemographic status, clinical teaching, and concerns about COVID-19.

Methods

A cross-sectional study was conducted using convenience sampling via an online self-administered questionnaire-based survey with 285 participants. The survey included questionnaires on sociodemographics, anxiety, depression, somatic symptoms, and stress levels using a validated questionnaire. Data was analyzed using Spearman’s correlation test and ordinal logistic regression to identify correlations between psychological well-being and the effectiveness of e-learning.

Results

More than half of the students reported anxiety (57.2%), depression (58.6%), somatic symptoms (54.4%) and moderate to high stress (79.7%) during the pandemic. Students who stated that online role players were not helpful had increased anxiety levels (rho=-0.18, P=0.005). However, somatic symptoms were reduced among students who found campus role players helpful (rho=0.16, P=0.012). More than half the participants (55.8%) felt that they were supported by the university during the COVID-19 pandemic, although most students (91.6%) sought clear information and prompt updates from the university. We found that students with psychological distress experiencing anxiety (OR=2.47, 95% confidence interval, CI=1.49-4.08), depression (OR=3.22, 95% CI=1.94-5.34), somatic symptoms (OR=2.94, 95% CI=1.76-4.91, P<0.001), and stress (OR=3.08, 95% CI=1.76-5.41) would value more mental health support from the university.

Conclusions

The university should consider increasing campus role-play sessions and providing prompt updates and mental health resources to help students cope better psychologically during the pandemic.

Impact of Online-Only Instruction on Preclinical Medical Education in the Setting of COVID-19: Comparative Analysis of Online-Only Vs. Hybrid Instructions on Academic Performance and Mental Wellbeing

INTRODUCTION

With the onset of the COVID-19 pandemic, many medical schools were forced to adopt a virtual learning environment. The purpose of this study is to investigate the impact of online-only instruction compared to online and in-person (hybrid) instruction on educational performance, wellbeing, and course satisfaction.

METHODS

We performed a descriptive cross-sectional survey of second-year medical students following a transition to online-only and hybrid instruction. Of the 198 total students, we collected 61 responses (42.6% [N = 26] male, 55.7% [N = 34] female, 1.6% [N = 1] preferred not to specify). 49.2% of the participants were in the online-only group. 50.8% of the participants were in the hybrid group.

RESULTS

There was a significantly lower mean final grade in the online-only group compared to the hybrid group (p = 0.04293). In contrast, there was no significant difference in measures of wellbeing (p = 0.6858) or course satisfaction (p = 0.9332).

CONCLUSION

Our study suggests that hybrid instructional delivery may be more effective than online-only instructional delivery for academic performance. However, there was no significant difference in mental wellbeing between either form of teaching. Students report that mental wellbeing was considerably impacted by factors related to the home environment as well as by unique concerns associated with the COVID-19 pandemic. While the online-only model may have been the safest-and only-option for many medical schools during the COVID-19 pandemic, we advise caution in transitioning to a complete online format without carefully designing the online curriculum to account for the negative impact it may have on student education.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01650-6.

COVID-19 and mental health: A systematic review of international medical student surveys

Background

The medical school curriculum has imposed psychological stressors on students worldwide, some of which may induce feelings of increased depression and anxiety. Meanwhile, the COVID-19 pandemic has exacerbated the feelings of stress, depression, and anxiety that a portion of medical students experience in their daily life. The aim of this systematic review is to gather concrete data from medical schools around the globe, and further evaluate how the COVID-19 pandemic has impacted medical students' mental health.

Materials and methods

Systematic search of data from PubMed, EMBASE, psycINFO, MEDLINE Complete, and Global Health for studies conducted between December 2019 and July 2021 was conducted. Data from 47 different surveys of medical students from various medical institutions throughout the world were included in this review. These surveys, administered in the form of questionnaires that utilized rating scales, measured anxiety, depression, and stress levels in medical students amidst the COVID-19 outbreak.

Results

The COVID-19 outbreak was found to have negative effects on medical students, most notably causing emotional and behavioral changes and detrimental mental health impacts. Higher levels of stress, depression, and anxiety have been found in medical students since the outbreak.

Conclusion

This systematic review highlights the sustained high prevalence of moderate depression, anxiety and stress among medical students during the COVID-19 pandemic. Appropriate support and research on which interventions could mitigate these risks is essential in order to ensure that future physicians are properly cared for, and ultimately have the adequate tools needed to provide high quality and empathetic care to future patients.

A scoping review of the literature on the impact of the COVID-19 quarantine on the psychological wellbeing of medical students

BACKGROUND

The goal of this study was to identify the nature and extent of the available published research on the impact of social isolation, on the psychological wellbeing of medical students, who had to quarantine due to the COVID-19 pandemic.

METHODS

Design. Scoping review.

SEARCH STRATEGY

The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews), guideline, was used to structure this study. A search strategy was carried out across six bibliographic databases. PubMed, Embase, ERIC, Scopus, Cochrane Database of Systematic Reviews and Web of Science. The following search terms were used, "medical student*" AND "impact" AND "quarantine" AND "COVID-19". Searches were initially confined to articles published (excluding conference abstracts) between 1 January 2019- 21 August 2021 but updated in September 2022 with the original search terms expanded to include "isolation" or "lockdown" as well as "quarantine" and the period of search extended to 21 August 2022. A search of secondary references was conducted. Data from the selected studies were extracted, and the following variables recorded; first author and year of publication, country of study, study design, sample size, participants, mode of analysing impact of quarantine from COVID-19 on mental health and results of the studies.

RESULTS

A total of 223 articles were identified in the original search in 2021 and 387 articles, in the updated search in 2022. Following the exclusion of duplicates and application of the agreed inclusion and exclusion criteria, 31 full-text articles were identified for the final review, most of which were cross sectional studies. Sample sizes ranged from 13 to 4193 students and most studies used a variety of self-administered questionnaires to measure psychological wellbeing. Overall, 26 of the 31 articles showed that quarantine had a negative impact on the psychological well-being of medical students. However, two studies showed no impact, and three studies showed an improvement.

CONCLUSION

The evidence is growing. Quarantine because of the COVID-19 pandemic may have had a negative impact on the psychological wellbeing of medical students, but this is not certain. There is therefore a need for more studies to further evaluate this research question.

T. MS, Barakat M, Abdelaziz DH, Mansour NO, Thabit AK, Ramatillah DL, Al-Jumaili AA, Syed NK, Adam MF, Hossain MS, Baraka MA, Jose J, Elkalmi R, Chandran S, Singh Dehele I, Elrggal M, Fathelrahman AI. Assessment of mental wellbeing of undergraduate pharmacy students from 14 countries: The role of gender, lifestyle, health-related, and academic-related factors

Background

Pharmacy students will assume future roles as frontline healthcare providers. Therefore, evaluating their current state of mental wellbeing and its associated factors is essential for better planning students' support initiatives. This study aimed to assess mental wellbeing and its associated factors among undergraduate pharmacy students from 14 countries during the pandemic.

Methods

A cross-sectional study was conducted among undergraduate pharmacy students in 14 countries in Asia and the Middle East. The validated Warwick-Edinburgh Mental Wellbeing Scale (the 14-item WEMWBS) was adopted to assess mental wellbeing. Data collection was performed online between February and April 2022. Descriptive and inferential statistics were used as appropriate.

Results

A total of 2,665 responses were received, mainly from females (68.7%) with a higher presence of private universities (59.1%). About 34.9% had low mental wellbeing levels, while 57 and 8.1% had medium, and high levels, respectively. Binary logistic regression showed that males (AOR: 1.34; CI 95%: 1.11-1.61; p < 0.01) and students with no chronic illnesses (AOR: 2.01; CI 95%: 1.45-2.80; p < 0.001) were more likely to have higher mental wellbeing. Also, participants who did not engage in any exercise (AOR: 0.71; CI 95%: 0.52-0.98; p = 0.04) and those in public universities (AOR: 0.82; CI 95%: 0.69-0.97; p = 0.02) were less likely to have higher mental wellbeing. Additionally, students who had interest/passion for pharmacy (AOR: 1.69; CI 95%: 1.07-2.68; p = 0.02), and those who known pharmacists inspired (AOR: 1.81; CI 95%: 1.06-3.12; p = 0.03), were more likely to have higher mental wellbeing compared with those who had no specific reason for their choice to study pharmacy. The participants with excellent (AOR: 1.87; CI 95%: 1.29-2.70; p = 0.001) or very good self-reported academic performance (AOR: 1.57; CI 95%: 1.12-2.22; p = 0.01) were more likely to have higher mental wellbeing compared to those with fair academic performance.

Conclusion

More than a third of the participants had low mental wellbeing. Various demographic, lifestyle, medical and academic factors appeared to affect students' mental wellbeing. Careful consideration of these factors and their integration into the pharmacy schools' plans for student support services and academic advising would be essential to improve students' mental wellbeing.

Moderating Effects of Self-Esteem on the Relationship between Communication Anxiety and Academic Performance among Female Health College Students during the COVID-19 Pandemic

Unprecedented quarantine due to COVID-19 exposes individuals to withdraw from face-to-face interactions, which may influence communication and self-esteem (SE). Therefore, the overarching aims of this study are to examine the communication apprehension levels among female college students, and thus to investigate the moderating role of self-esteem on the relationship between communication apprehension and academic achievement. In this cross-sectional study, 287 female college students completed the survey, which was circulated through email. The survey included the following questionnaires: General Health Characteristics, Rosenberg Self-esteem Scale, and Personal Report of Communication Apprehension Scale. The results showed that 28.2% of participants were categorized as having a high level of communication apprehension, and only 9.8% had a low level of communication apprehension. The SE reported an overall score of 24.3 ± 2.14, indicating a high self-esteem level among students. The students' grade point average (GPA) was positively correlated with SE. However, self-esteem as a moderator variable had no significant effect on the relationships between all predictors and GPA. The finding of the study highlights the need to implement different strategies to enhance students' group discussions, meetings, and interpersonal communication to ensure the best learning outcomes. Future studies are required to investigate gender-based disparities in the relationship between communication apprehension and SE.

Academic self-efficacy, self-esteem, satisfaction with studies, and virtual media use as depression and emotional exhaustion predictors among college students during COVID-19

The aim of the study was to explore the relationship between depression, emotional exhaustion, self-esteem, satisfaction with studies, academic self-efficacy, and the use of virtual media in Peruvian university students during the coronavirus disease 2019 (COVID-19) pandemic. A total of 569 college students (61.9% female), with a mean age of 21.73 years (standard deviation = 4.95), responded to the following questionnaires: Academic Self-Efficacy Scale, Single Item Self-Esteem Scale, Brief Scale of Satisfaction with Studies, Scale of Use of Virtual Media, Patient Health Questionnarie-2, and Single Item of Academic Emotional Exhaustion. Correlation statistics, regression models, and structural equation modeling (SEM) were used for data analysis. The results demonstrated a direct and significant correlation between virtual media use, academic self-efficacy, self-esteem, depression, and emotional exhaustion (p <.01). In addition, satisfaction with studies (β = −0.13), academic self-efficacy (β = −0.19), self-esteem (β = −0.14), and emotional exhaustion (β = 0.19) predicted depression significantly, whereas virtual media use (β = 0.17), study satisfaction (β = 0.09), and depression (β = 0.20) predicted emotional exhaustion associated with academics. The SEM model indicated that self-esteem, satisfaction with studies, and academic self-efficacy negatively predict depression, whereas academic self-efficacy positively predicts virtual media use. Finally, both virtual media use and depression positively predict emotional exhaustion. This model presents optimal goodness-of-fit indices (X² = 8.926, df = 6, p =.178; comparative fit =.991, Tucker–Lewis =.979, root mean square error of approximation =.029 [confidence interval 90% =.000–.067], standardized root mean square residual =.022). Thus, academic self-efficacy, self-esteem, satisfaction with studies, and virtual media use predict depression and emotional exhaustion among college students during the COVID-19 pandemic.

Attitude and Performance for Online Learning during COVID-19 Pandemic: A Meta-Analytic Evidence

The COVID-19 pandemic prominently hit almost all the aspects of our life, especially in routine education. For public health security, online learning has to be enforced to replace classroom learning. Thus, it is a priority to clarify how these changes impacted students. We built a random-effect model of a meta-analysis to pool individual effect sizes for published articles concerning the attitudes and performance towards online learning. Databases included Google Scholar, PubMed and (Chinese) CNKI repository. Further, a moderated analysis and meta-regression were further used to clarify potential heterogenous factors impacting this pooled effect. Forty published papers (n = 98,558) were screened that were eligible for formal analysis. Meta-analytic results demonstrated that 13.3% (95% CI: 10.0-17.5) of students possessed negative attitudes towards online learning during the COVID-19 pandemic. A total of 12.7% (95% CI: 9.6-16.8) students were found to report poor performance in online learning. Moderated analysis revealed poor performance in online learning in the early pandemic (p = 0.006). Results for the meta-regression analysis showed that negative attitudes could predict poor learning performance significantly (p = 0.026). In conclusion, online learning that is caused by COVID-19 pandemic may have brought about negative learning attitudes and poorer learning performance compared to classroom learning, especially in the early pandemic.

Effects of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health: systematic review

BACKGROUND

A rise in mental illness is expected to follow the COVID-19 pandemic, which has also been projected to lead to a deep global economic recession, further adding to risk factors.

AIMS

The aim of this review was to assess the impact of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health.

METHOD

Searches were conducted in PubMed, Web of Science, PsycINFO and Sociological Abstracts. We included studies of all populations exposed to the COVID-19 pandemic, and other similar pandemics/epidemics and economic crises, compared with non-exposed time periods or regions. The outcome was mental health.

RESULTS

The 174 included studies assessed mental health impacts of the COVID-19 pandemic (87 studies), 2008 economic crisis (84 studies) and severe acute respiratory syndrome (SARS) epidemic (three studies). Outcomes were divided into affective disorders, suicides, mental healthcare utilisation and other mental health. COVID-19 pandemic studies were of lesser quality than those for the economic crisis or SARS epidemic. Most studies for all exposures showed increases in affective disorders and other mental health problems. For economic crisis exposure, increases in mental healthcare utilisation and suicides were also found, but these findings were mixed for COVID-19 pandemic exposure. This is probably because of quarantine measures affecting help-seeking and shorter follow-ups of studies of COVID-19 pandemic exposure.

CONCLUSIONS

Our findings highlight the importance of available, accessible and sustainable mental health services. Also, socioeconomically disadvantaged populations should be particular targets of policy interventions during the COVID-19 pandemic.

The Consequences of the Pandemic on Medical Students’ Depressive Symptoms and Perceived Stress: A Repeated Cross-Sectional Survey with a Nested Longitudinal Subsample

This study aimed to explore the impact of the pandemic on medical students’ mental health in Italy using a repeated cross-sectional survey with a nested longitudinal subsample (first timepoint: 2018; second: 2020/2021). Three research questions (RQs) were investigated. Study 1 (longitudinal sub-sample) explored whether medical students had higher levels of depressive symptoms and stress during the pandemic compared with a pre-pandemic period (RQ1) and what variables were associated with these conditions during the pandemic adjusting for baseline levels (RQ2). Study 2 (repeated cross-sectional data) aimed to examine whether medical students had higher levels of these conditions during the pandemic compared with their same-year peers during a pre-pandemic period (RQ3). In Study 1, higher levels of depressive symptoms and stress were shown during the pandemic (RQ1). Multivariable models highlighted associations between poor mental health and worsening of the judgment of medical school choice, worsened psychological condition due to the pandemic, economic repercussions due to the pandemic, and baseline levels of symptoms (RQ2). In Study 2, our findings reported higher levels of depressive symptoms and stress during the pandemic, also adjusting for other variables (RQ3). In conclusion, depressive symptoms and stress were greater during the pandemic. The most relevant variables were pandemic-related items and medical school choice judgment.

Red blood cell distribution width to predict mortality in heart transplant recipients: a systematic review

Red blood cell distribution width (RDW) has been shown to have prognostic value in a number of different clinical settings, such as cardiovascular disease, including heart failure. However, its prognostic value in heart transplant (HT) recipients remains unknown. The aim of this systematic review is to determine the prognostic value of pre-transplant RDW for mortality in HT recipients. There is a pre-published protocol of this review. The terms "Heart transplant", "Red cell distribution width" and their synonyms were used in the search strategy. PubMed/Medline, Embase, Scopus, Web of Science and LILACS were searched until May 17th, 2022, without date or language restrictions. Two authors independently carried out the selection, first by title and abstract, second by full-text revision. Discrepancies were discussed and resolved with three other authors. Quality of individual studies was assessed with Newcastle Ottawa Scale (NOS) for cohorts. After removing the duplicates, 3885 articles were identified. Four articles were included in the qualitative synthesis. Three studies were classified as “good quality”: whereas one as “poor quality” according to NOS scale. All the included articles evaluated long-term mortality and one study also evaluated short-term mortality. In this one, a correlation between higher RDW values and short-term mortality was reported. Meanwhile, in all the studies, a high pre-HT RDW was a marker of long-term mortality following cardiac transplantation. Our review shows that an elevated on-admission RDW is associated with long-term mortality in heart transplantation recipients.

Prevalence of burnout in medical students: A systematic review and meta-analysis

BACKGROUND

Medical students are at a significant risk of experiencing psychological issues, such as burnout. Over the past few years, more studies have been conducted on this topic, producing different results.

AIMS

The purpose of this review was to determine the global pooled prevalence rate and risk factors associated with burnout and its components among undergraduate (pre-intern) medical students.

METHOD

From inception until 30 November 2021, nine electronic databases were used for an electronic search. Using random-effects meta-analysis, we pooled the estimates using the DerSimonian-Laird method. The prevalence of burnout in medical students was the primary outcome of interest. Data were analyzed globally, by country, by research measure. Age and sex were examined as confounders using meta-regression analysis.

RESULTS

A random-effects meta-analysis of 42 studies involving 26,824 evaluating the prevalence of burnout in medical students showed an overall prevalence rate 37.23% [32.66%; 42.05%], Q = 2,267.15(41), p < .0001, τ² = .42, τ = .65, I² = 98.2%; H = 7.5. Prevalence of emotional exhaustion, depersonalization, and personal accomplishment were 38.08% [30.67%; 46.10%], 35.07% [26.74%; 44.41%], and 37.23% [32.66%; 42.05%], respectively. Variations were observed between countries and research measures. Age (older) and sex (female) were both significant predictors of burnout.

CONCLUSION

The prevalence of burnout in medical students was estimated to be 37.23%. It is urgent that future studies serve as a basis for the development of prevention and treatment programs to prevent and treat burnout in students.

Experiences of academic and professional burn-out in medical students and residents during first COVID-19 lockdown in Belgium: a mixed-method survey

COVID-19 has presented a substantial burden on students and healthcare staff. This mixed-method, descriptive and correlational study aimed to: 1) describe academic; and 2) professional burnout levels; 3) their associations with working in COVID-19-related care; and 4) with perceived COVID-19 impact on studies and internships among medical students and residents. We hypothesized burnout levels to be high; those involved in COVID-19 care to experience higher impact of COVID-19 on studies and work, and to experience higher levels of academic and professional burnout than those not involved in COVID-19 care; academic and professional burnout to be higher when perceived burden due to COVID-19 was higher. During first lockdown in Belgium, a mixed-method cross-sectional survey assessed academic burnout (MBI-SS) and professional burnout in relation to internships and residency (MBI-HSS). Correlations and t-tests tested associations of burnout with involvement in COVID-19-related care and perceived impact of COVID-19 on studies and work (SPSS). Participants provided open-ended comments which were thematically analysed (NVivo). In total, 194 medical students and residents participated (79.5% female, M age = 24.9 ± 2.5). Emotional exhaustion and depersonalisation were high in professional burnout, but moderate in academic burnout. Those involved in COVID-19 related care perceived a higher impact of COVID-19 on their studies and internship/residency and have higher professional burnout, but do not show a higher academic burnout. Those who have a higher perceived impact of COVID-19 on their studies scored higher on academic burnout. Participants mentioned an increased workload (e.g., having to be constantly available and constantly adapt), distress (e.g., uncertainty, fatigue, fear for impact on significant others), fewer learning opportunities (e.g., cancelled internships, changing learning methods), lack of relatedness with patients and supervisors (e.g., lack of respect and understanding from supervisors, distance created by phone consultations with patients) and cynicism towards remote care or non-medical tasks (e.g., considering what they do is not useful or not what they trained for). Students and residents showed indications of professional and academic burnout in relation to the COVID-19 situation. Interventions are needed that can meet the needs of achieving learning outcomes, managing extreme situations and relatedness.

Impact of COVID-19 pandemic on medical students: a scoping review protocol

INTRODUCTION

The COVID-19 pandemic has spread globally and has been reported in every known country. The effects can be felt in universities and schools, shifting their learning to online platforms. However, medical schools bear the burden of protecting students and ensuring the continuation of the education process. The rapid transition to online learning, coupled with the lack of preparation from the educational system, leads to stresses that affect students' academic performance, mental health and social life. Nevertheless, no review tried to synthesise the complete picture of the pandemic's effects. Therefore, this scoping review aims to identify and explore the available literature on the effects or impacts of the pandemic on medical students without limiting it to specific dimensions.

METHODS

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and the Joanna Briggs Institute manual for evidence synthesis. We examine articles reporting data from any country. However, only articles written in English will be included. For studies to be included, they must report any form of impact on medical students, qualitatively or quantitatively. Furthermore, the impact must occur within the context of the COVID-19 pandemic. Searches will be done on Medline, EMBASE, ERIC, the Cochrane Library, CINAHL and PsycInfo. After data extraction, we will narratively synthesise the data and explore the types of impacts COVID-19 has on medical students.

ETHICS AND DISSEMINATION

No formal ethical approval is required. The scoping review will be published in peer-reviewed journals and as conference presentations and summaries, wherever appropriate.

Anxiety, Stress Coping Styles and Hope for Success among Graduate Students and High School Graduates during the COVID-19 Pandemic: The Moderating Role of Remote Learning

The COVID-19 pandemic has significantly influenced the area of education, in terms of both teaching and learning effectiveness. The aim of the study was to compare groups of high school graduates and graduate students. The Coping Inventory in Stressful Situations (CISS), State and Trait Anxiety Inventory (STAI), Hope for Success Questionnaire (KNS), and our own questionnaire were used in the study. The results of the research show that the group of high school graduates, compared to the graduate students, was characterized by a higher level of anxiety, a style focused on emotions and a lower level of hope for success. People who passed the exam in the online form were characterized by a higher level of anxiety compared to the respondents who passed the exam in the stationary form. According to the results of this study, it can be concluded that the styles of coping and the level of hope for success may be both protective and risk factors related to the level of anxiety during distance learning.

A Large-Scale Dataset of Twitter Chatter about Online Learning during the Current COVID-19 Omicron Wave

The COVID-19 Omicron variant, reported to be the most immune-evasive variant of COVID-19, is resulting in a surge of COVID-19 cases globally. This has caused schools, colleges, and universities in different parts of the world to transition to online learning. As a result, social media platforms such as Twitter are seeing an increase in conversations related to online learning in the form of tweets. Mining such tweets to develop a dataset can serve as a data resource for different applications and use-cases related to the analysis of interest, views, opinions, perspectives, attitudes, and feedback towards online learning during the current surge of COVID-19 cases caused by the Omicron variant. Therefore, this work presents a large-scale, open-access Twitter dataset of conversations about online learning from different parts of the world since the first detected case of the COVID-19 Omicron variant in November 2021. The dataset is compliant with the privacy policy, developer agreement, and guidelines for content redistribution of Twitter, as well as with the FAIR principles (Findability, Accessibility, Interoperability, and Reusability) principles for scientific data management. The paper also briefly outlines some potential applications in the fields of Big Data, Data Mining, Natural Language Processing, and their related disciplines, with a specific focus on online learning during this Omicron wave that may be studied, explored, and investigated by using this dataset.

Mental Health of Medical Students Before and During COVID-19 Pandemic: a 3-Year Prospective Study

BACKGROUND

Very few studies prospectively analyzed medical students' mental health before and during the COVID-19 pandemic. This study aimed to prospectively evaluate mental health in medical students in 2018, 2019, and 2020 during the COVID-19 pandemic lockdown.

METHODS

All students from first to fourth year were invited to participate in 2018. These students were also invited to participate in the same period in 2019 and 2020 (during the peak of the COVID-19 lockdown). The Self-Reporting Questionnaire (SRQ-20), created by the WHO to investigate 20 nonpsychotic psychiatric symptoms, was used to evaluate common mental disorders. The cut-off for relevant symptom severity for mental distress is seven (SRQ-20 ≥ 7).

RESULTS

In the years 2018, 2019, and 2020, a total of 860 SRQ-20 questionnaires were completed. Overall, mean SRQ-20 scores were 8.2 ± 4.6, and SRQ-20 ≥ 7 frequency was 60.5%. When comparing the years 2018, 2019, and 2020, no differences were found for either SRQ-20 scores (8.4 ± 4.7, 8.2 ± 4.6, and 7.8 ± 4.4, respectively; p = 0.351) or SRQ-20 ≥ 7 frequency (62.2%, 60.9%, and 59.2%, respectively; p = 0.762).

CONCLUSION

In contrast to our initial hypothesis, stable results on mental health measures were found even during the 2020 COVID-19 lockdown. Maintenance of daily routines through distance learning and the continuation of adapted clerkship activities with strict safety measures could have contributed to these results. However, this study points to high overall levels of common mental disorders, especially among women. Further studies should be conducted to understand all the factors responsible for such stability, such as social and economic support, resilience, or even previous high levels of common mental disorders.

A systematic review of health sciences students' online learning during the COVID-19 pandemic

BACKGROUND

This study aims to analyse the effectiveness of distance learning during the COVID-19 pandemic among undergraduate health sciences students using systematic review. Online learning has been chosen as the best approach to continue offering education in this pandemic era.

METHOD

The screening process was done using Scopus, ScienceDirect and PubMed based on the eligibility criteria. Out of 1486 studies, 1269 were screened. A total of 64 eligible studies obtained were included in the quantitative analysis. Results were categorized into i) student attitudes (perceptions/satisfactions/engagements), and ii) student learning outcomes, and compared to the Kirkpatrick model.

RESULTS

Although facing difficulties, 50% of the studies was moderately satisfied with distance learning, while 36% was highly satisfied and 17% dissatisfied. Most studies (26%) reported flexibility in online learning. Internet issues (19%) and low interaction between learners and instructors (19%) were the most prevalent problems mentioned. Online education engages students better than traditional learning. The learning outcome was assessed using two categories: i) academic performance and ii) skill development. Most studies (72%) stated that online learning improves academic performance, 14% reported a drop, and 14% stated no effect, while an increase in clinical skills and communication skills were reported. Kirkpatrick evaluation revealed 80% of the studies obtained was evaluated at level 1 (reaction), 8% at level 2 (learning), 12% at level 3 (behaviour) and none at level 4 (results).

CONCLUSION

Overall, this systematic review found that the online learning performed better than expected during COVID-19, but the data gained is insufficient to say it is beneficial when compared to other types of teaching approaches.

Prevalence of medical students’ satisfaction with online education during COVID- 19 pandemic: A systematic review and meta-analysis

Background: Electronic (E)-learning is defined as the use of electronic tools for education, training, and communication.(ERT) is defined as use of alternative methods of teaching such as remote learning during a crisis circumstances Education, among many other sectors, has been profoundly affected by the spread of the coronavirus disease 2019 (COVID-19). More than 90% of the world’s students are unable to attend teaching sessions due to the COVID-19 pandemic. Methods: This study was conducted in accordance with the published guidelines for meta-analysis and reviews (PRISMA) reporting guidelines. A database and electronic search was performed on September 21st, 2021 using PubMed, Medline and Embase through the OVID platform, and ScienceDirect. We removed duplicates, and screened the title, abstract, and full texts of included papers. We included studies published only in English and excluded studies without sufficient data, case reports, editorials, and protocols. The quality of included articles was examined using the AXIS tool for cross-sectional studies, and the Newcastle–Ottawa scale for observational case-control studies. From the included studies, demographic and satisfaction with online education (OE) prevalence data were extracted and analyzed. We calculated the pooled prevalence of medical students’ satisfaction. Results: Eighteen studies with a total sample of 7,907 students were included in the meta-analysis. The pooled prevalence of medical students’ satisfaction with online education was 57% (95% CI: 47 - 67%). Publication bias was assessed and reported. Conclusions: The pooled prevalence of medical students’ satisfaction with online education was 57 %. Online learning satisfaction was associated with students’ prior experience with OE. The greatest benefit of OE is overcoming obstacles faced with learning Major challenges for implementing OE were technical and infrastructural resources.

Associations Between Online Learning, Smartphone Addiction Problems, and Psychological Symptoms in Chinese College Students After the COVID-19 Pandemic

Background

Smartphone-based online education gained popularity during and after the COVID-19 pandemic. Although recent studies have highlighted the association between problematic smartphone use (PSU) and mental health symptoms, the potential role of online learning in this relationship remains unclear. This study aimed to analyze the relationships between higher education modes, PSU, and related psychological symptoms in university students.

Methods

A total of 1,629 Chinese university students from five provinces completed a web-based questionnaire survey between March 2020 and October 2021. Demographic characteristics and learning conditions were recorded. All participants completed the Smartphone Addiction Scale-Short Version, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Athens Insomnia Scale. Multiple regressions models and stratified analyses were used to examine the association between online education mode, PSU, and symptoms of depression, anxiety, and insomnia.

Results

The prevalence of PSU was 58.5%. Students who relied primarily on online learning had a higher prevalence of depressive symptoms (29.95% vs. 22.24%), anxiety symptoms (25.13% vs. 18.91%), and insomnia symptoms (75.89% vs. 70.27%) than those who relied on traditional face-to-face learning (Ps < 0.05). After adjusting for covariates, subjects with PSU were more likely to report depressive symptoms (AdjOR = 3.14, 95% CI = 2.26–4.37), anxiety symptoms (AdjOR = 3.73, 95% CI = 2.13–4.59), and insomnia symptoms (AdjOR = 2.96, 95% CI = 2.23–3.92) than those without PSU. Furthermore, the associations of PSU with depressive symptoms (OR = 4.66 vs. 2.33, P for interaction = 0.015) and anxiety symptoms (OR = 6.05 vs. 2.94, P for interaction = 0.021) were more pronounced in the online learning group.

Conclusion

Our study provides preliminary evidence that Chinese university students have serious smartphone addiction problems, which are associated with depressive, anxiety, and insomnia symptoms. Online learning is found to exacerbate PSU and mental health problems. Our findings provide valuable information for targeted psychological interventions in the post-COVID-19 era.

Psychological impact and stress factors among Ha'il medical students post COVID19 pandemic

The current COVID-19 pandemic frightfully threatened the whole world, and people in different countries were demanded to be quarantined due to possible contact with the infection. High mortality rate, the spread of COVID19 and the propagation of fake news in social media programs created fear and anxiety among majority of society especially, medical students. One of the most essential changes during the covid-19 was the termination of teaching lectures in physical presence and its replacement by virtual online lectures. Circumstances like these have negative impact on the mental health of medical students. Therefore, it is of interest to investigate the impact of the COVID19 pandemic on medical students' learning and the effect of distressing situation they experienced, psychological and educational variables specifically during return to physical attendance in college and the impact of these variables of probably affecting factors like age, gender, marital status, transition of preclinical years to clinical years. A Cross-sectional study was completed among medical students at UOH, KSA. The data are collected by distributing an online questionnaire. Statistical analysis has been done with Microsoft Power BI. 14.82% of 5th year female participants were unable to stop worrying for different things while 10.54% of male participant were in the 1st year. Large numbers of students who have increased the number of times they wash their hands are found in med3 and med4 while 27.92% agree and 29.05% strongly agree of whole years of study. 45.29% of students were having mental pressure before online session due to internet connection while 51.55% had decreased motivation since the shift to online learning. Data shows that highest numbers of participants who were having past illness and anxious were in age group 21-23 in both male and female. The majority of students was having fear toward returning in physical presence and preferred not to have on- college education. Hence, it is recommended to encourage students and reduce stress by providing with Personal Protective Equipment (PPE) course.