The impact of COVID-19 on first-year medical education – Insights and lessons learned from students pursuing careers in surgery

The COVID-19 pandemic affected medical education in countless ways. Per the Association of American Medical Colleges (AAMC) guidelines, medical schools and educators across the nation transitioned pre-clerkship curriculums to online formats, effectively ending face-to-face interaction with faculty and clinical opportunities for junior students.¹

Although the pre-clinical years are primarily spent in the classroom, it is imperative for students pursuing increasingly competitive surgical residencies to gain exposure to clinical medicine through shadowing and participate in research as early as their first year. These opportunities provide perspective to the pre-clinical curriculum. As students are inundated with basic science material in the absence of clinical context, they may become easily overwhelmed. In addition, the desire to provide quality patient care is a central tenet for medical students pursuing careers as surgeons. In order to provide exceptional care, students must possess good technical and communication skills, attainable only through practice and experience.² Amid the challenging two years of pre-clinical studies, medical students also find great reward in caring for and building relationships with members of their community.

As students wanting to pursue careers in surgery, many feel that the lack of interaction with patients and faculty has impacted this group more acutely than peers pursuing non-surgical disciplines. In a field where many health professions coordinate to treat a single patient, teamwork is a conceptual framework strongly emphasized as early as the first day of medical school.³ In fact, surgical teams that display poor teamwork behaviors have been linked to a greater risk for worse patient outcomes.⁴ With COVID-19 eliminating the vast majority of interactions among classmates and other medical professionals in the hospitals, students have felt isolated. While many schools transitioned to using standardized patients via Zoom to simulate a clinical patient interaction, this does not allow students to witness the daily collaboration between members of the healthcare team.

The temptation to feel “behind” with regard to clinical experience, coupled with the transition to medical school in a virtual format, has exponentially increased the rate of burnout – an issue that has consistently plagued the field of surgery.⁵ We know that an inverse relationship between student and faculty interaction and burnout exists, even without the added stressors associated with a pandemic.⁶ Most recently, we have found that during the COVID-19 pandemic, medical students now display higher levels of cynicism, lower mental health scores, and higher rates of burnout in many cases when compared to pre-pandemic cohorts.⁷

While vaccinations aid in returning society to normalcy, the long-term impact of COVID-19 on undergraduate medical education remains unknown. On July 27th, 2021, the Centers for Disease Control and Prevention (CDC) updated their guidelines, recommending masking indoors in schools for both unvaccinated and vaccinated individuals.⁸ As numerous variants arise at home and abroad, many hospitals and academic medical centers are again at capacity limits.

That being said, we feel that junior medical students should be allowed to pursue clinical exposure with faculty in surgical specialties. Asking upperclassmen to help bridge a connection may be a good alternative in situations of limited contact. In addition, medical students should lean on peers and professors for accountability and support in networking endeavors. One of the earliest and easiest ways to form connections with faculty as a first-year student is to join a surgery interest group. Regardless of the state of the pandemic, students can meet and learn from surgeons, whether it be in-person or even over Zoom. Interest groups can recruit surgeons for talks and panels or hold events such as socially distanced suture workshops. Seeking mentorship with older students, residents, and faculty is also imperative. The journey to a surgical career is long, but mentorship, even in the preclinical years, can guide students and give them a realistic picture of the field they are pursuing.

In addition to seeking opportunities in surgery, students should continue to employ tactics to decrease the likelihood of burnout. The transition to medical school is difficult for most, especially amidst a pandemic, but a strong support network ensures success even if tough times arise. Activities such as exercise, study breaks, and spending time with friends or family, even if this time must be spent via socially distanced methods, can help maintain student wellness. It is logical to believe that one of the primary reasons for higher burnout rates for medical students during the COVID-19 pandemic was isolation; therefore, we want to highlight the importance of developing a support system in some manner.⁷

Our experience during the first year of medical school has explicitly shown us that relationships with peers and faculty mentors are necessary core components of the medical education system, and we hope that future students do not take these relationships for granted when the specter of COVID-19 has been removed. Meanwhile, if we fail to expose medical students to surgical disciplines early in medical school, we may miss the opportunity to recruit the best and the brightest into the field of surgery.

Declaration of competing interest

None of the authors have financial conflicts to disclose.