Table 2.

Impact of COVID-19 on medical education, training and mental health of medical students and trainees.

Study	Country/continent or region	Population	Variables/challenges	Impact/assessment
Olum et al. (17)	Uganda/Africa	n = 741 1st to 5-year medical students	Knowledge, attitude and practices	Good knowledge, attitude and practices. 80% of students willing to participate in frontline care if required.
Nguyen et al. (18)	Vietnam/Asia	n = 5423 Medical students from eight different medical schools	Fear of COVID-19 (via the validated fear of COVID-19 scale)	Better health literacy, older age, later academic years, male gender and better financial status were protective from fear. Those with greater fear scores were more likely to smoke and drink at an unchanged or higher level than before the pandemic.
Flotte et al. (19)	USA/North America	n = 57 Final year Medical Students	Students were graduated early and participated in the workforce as limited license physicians	Were able to be deployed in “pods” of 3–4 and provide support to physicians. Received positive feedback.
Compton et al. (20)	Singapore/Asia	N = 179 All medical students at a graduate entry medical school in Singapore	Return to the clinical setting	Approximately one-third of students did not wish to return to the clinical setting, with the major concern being negatively influencing patient outcomes.
Chandra et al. (21)	USA/North America	n = 67 Senior Medical Students	Concerns around the inability to partake in emergency medicine clinical environments	Online teleconferencing was used to give students the ability to carry out follow-ups with discharged patients. Students reported positive feedback and benefits to their clinical reasoning from discussing with staff members. Additionally, they were pleased with feeling worthwhile in the pandemic.
Collado-Boira et al. (22)	Spain/Europe	n = 62 Final year medical (23) and nursing (24) students	Willingness to participate in the health workforce Fears about infection, familial transmission, lack of PPE, confidence in terms of knowledge and skills and coping	85.5% of recipients voluntarily joined, with the major reason being a desire to help in the COVID-19 situation. There were profound fears in all domains, particularly with respect to familial transmission, their practical knowledge and skills, and coping with the death of patients.
Khanna et al. (25)	India/Asia	n = 2,355 Ophthalmologists and ophthalmologists-in-training	Impact on training or professional work. Financial Implications. Symptoms of depression using PHQ-9 validated scale	52.8% felt their training or professional would be seriously affected by COVID-19, 37% reported difficulties meeting financial commitments and 32.6% had some degree of depression.
Zingaretti et al. (26)	Italy/Europe	N = 115 Plastic surgery residents in Italy	Impacts of COVID-19 on didactic teaching and professional development	Whilst residents reported increased didactic activities compared to pre-COVID, the majority reported them as insufficient. Additionally, most reported their preparedness for operations as either “Not at all” or “Not Much.”
Taghrir et al. (27)	Iran/Middle East	n = 240 5th to 7th year Iranian Medical Students	Knowledge, preventive behaviors and risk perceptions surrounding COVID-19.	Good knowledge, and high rates of preventative behaviors. Risk perception was moderate but tended to vary between different groups.
Guadix et al. (28)	USA/North America	n = 127 1st to 4th Medical Students	Impacts of the COVID-19 pandemic on medical student attendance on neurosurgery training camps	Postponement and cancellation were widespread (76%), and there were profound concerns surrounding conferences and networking opportunities, clinical experience and board examinations. Interestingly, 1st and 2nd-year students wanted virtual mentorship to address this, whereas 3rd and 4th preferred virtual surgical skills workshops.
Li et al. (29)	China/Asia	N = 1,442 Health professional students (764 medical, 211 nursing, and 467 medical technology)	Factors associated with psychological distress during the COVID-19 pandemic	26.63% of students had psychological distress that was clinically significant, whilst 11.10% had a probable acute stress reaction. Those with childhood adversity, stressful life event experiences in the past year and internet addiction were at greater risk, whereas good family functioning was protective.
Aker et al. (30)	Turkey/Middle East	N = 1,375 Medical Faculty Students	Views surrounding the COVID-19 pandemic	Over half of the students used social media as their source of information, but the majority did not trust this. About half of the students were concerned about receiving education in locations where COVID-19 patients were treated and would not want internships in such locations.
Bhagavathula et al. (31)	Global (308 respondents from Asia)	n = 453 Healthcare workers (137 doctors and 134 medical students)	Determination of the knowledge and perceptions related to COVID-19	Most participants obtained their information and knowledge surrounding COVID-19 from social media. Knowledge surrounding incubation period and transmission were poor. Doctors were found to be more well-informed than allied health workers.
Garcia et al. (24)	USA/North America	N = 315 (Medical students and foreign medical graduates working at US medical schools)	Determining the impact of the COVID-19 pandemic on medical students considering/already transitioning to neurosurgical careers	Approximately 2/3 of respondents reported postponement of clinical placements and suspended in-person teaching. Greater than 50% of respondents reported reduced academic productivity. One in five first-year medical students reported that they are less likely to pursue neurosurgery as a career option. Student-focused webinars and student-focused sessions at upcoming neurosurgical conferences were favored by students as ways to address these issues.
Liu et al. (32)	China/Asia	n = 217	Mental health status of medical students in Wuhan, China	35.5% of students were in a state of depression and 22.1% anxiety. The majority of affected students had mild to moderate symptoms
Khasawneh et al. (33)	Jordan/Middle East	n = 1,404 1st to 6th-year medical students	Knowledge, attitude, perceptions, and precautions surrounding COVID-19	Most students obtained their information from social media for information about COVID-19. There was adequate knowledge and appropriate precautionary strategies were carried out.
Meo et al. (34)	Saudi Arabia/Middle East	n = 625 1st to 5th-year Medical Students	Psychological well-being, stress and learning behaviors.	Feelings of emotional detachment and disheartenment were prominent. Additionally, students felt their work performance and time spent studying was reduced.
Abbasi et al. (35)	Pakistan/Asia	n = 382 Medical and Dentistry Students	Attitudes and perceptions surrounding e-learning	Most students had negative perceptions surrounding e-learning and preferred face-to-face learning. Many students used their mobile devices for e-learning purposes.
Sethi et al. (36)	Pakistan/Asia	n = 290 Healthcare professionals	Impacts of the shutdown on daily lives and health	For academics, work-life balance issues were identified as online teaching was an addition to extensive clinical work. Ensuring mental health impacts were reported. For some clinicians in training, academic delays and subsequent financial impacts were a concern. There were concerns about the lack of PPE.
Ikhlaq et al. (37)	Pakistan/Asia	n = 384 Medical, dental, nursing and allied health students	Awareness and attitudes	A resounding majority were aware of the etiology, mode of transmission and possible symptoms, but in-depth knowledge was lacking. Medical and nursing students had better knowledge. Most students showed positive attitudes, but a substantial proportion had fears around familial transmission. There were also concerns around the government's ability to address the COVID-19 pandemic.
Lin et al. (38)	China/Asia	n = 2,086 Medical students from a single medical school in Fujian, China	Impacts of mass and social media on psychobehavioural responses to the COVID-19 pandemic	Both mass and social media exposure assisted in increasing positive attitudes and reducing emotional consequences and behavioral prevention barriers
Choi et al. (39)	United Kingdom	n = 440 Final year medical students from 32 UK medical schools	Impacts on student learning and confidence for their 1st year of training	Significant impacts on student's preparedness due to impacts on OSCEs, written exams and student assistantships. The latter also had confidence implications.
Çalişkan et al. (40)	Turkey/Middle East	n = 860 Final year medical students	Knowledge and perceptions toward COVID-19	Moderate knowledge. Those with better knowledge had lesser fear. Most students reported not having been trained until the pandemic hit Turkey. Many students also felt unprepared if required to assist in the emergency department.