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| ORIGINAL ARTICLE |
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| Ahead of print publication |
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Perceived impact of the prolonged COVID-19 pandemic on Malaysian medical students: A descriptive, cross-sectional study
Sapna S Patil1, Ameya A Hasamnis1, Karuthan Chinna2, Nicole Gan Wei Wei1, Britney Ng Rae Min3
1 School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
2 Faculty of Business and Management, UCSI University, Cheras, Malaysia
3 School of Liberal arts and Sciences, Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Malaysia
| Date of Submission | 02-Mar-2022 |
| Date of Decision | 21-May-2022 |
| Date of Acceptance | 02-Jun-2022 |
| Date of Web Publication | 19-Jul-2022 |
Correspondence Address:
Sapna S Patil,
No. 1 Jalan Taylor's, School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Selangor
Malaysia
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjdrdypu.mjdrdypu_180_22
Background: The coronavirus disease 2019 (COVID-19) pandemic has caused an unprecedented disruption in the lives of students and health care systems worldwide. Objectives: The study explored the impact of the prolonged COVID-19 pandemic among medical students in Malaysia. Methods: An online, cross-sectional survey was conducted among 397 medical students using Google forms circulated on social networking sites, like WhatsApp. Data were collected on self-reported anxiety and preventive health behaviors, challenges faced in daily activities, perception of e-learning, and changes in social and personal relationships. Results: As compared to before the advent of the pandemic, 83% of the students were more nervous and anxious, 38% washed their hands more often, and 43% bought more cleaning and hygiene supplies during the pandemic. Forty-two percent of the respondents went out less often, and 73% had lesser in-person social contact with their friends. The majority of students practiced a sedentary lifestyle; 47% snacked more often, and 58% had lesser physical activity. Conclusion: This study emphasizes the role of the provision of emotional support and strategies to enhance the well-being of medical students.
Keywords: COVID-19 pandemic, hardships, Malaysia, medical students
How to cite this URL:
Patil SS, Hasamnis AA, Chinna K, Wei Wei NG, Rae Min BN. Perceived impact of the prolonged COVID-19 pandemic on Malaysian medical students: A descriptive, cross-sectional study. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2023 Mar 20]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=351327 |
| Introduction | |  |
The coronavirus disease 2019 (COVID-19) pandemic has become a global crisis with potentially devastating health, socioeconomic, and humanitarian consequences.[1] Over a year into the pandemic, countries worldwide are still grappling with its unprecedented impact. Working from home, travel restrictions, lack of physical contact with friends and family, and lockdowns are the 'new normal.'
According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), globally, the learning of nearly 1.6 billion students on all levels in 194 countries has been disrupted due to the closure of academic institutions.[2] For medical students, undoubtedly, hands-on experience of bedside clinical exposure, and learning in community settings has been compromised.
In Malaysia, the nationwide Movement Control Order (MCO) enforced in March 2020, called for higher education institutions (HEIs) to swiftly transform teaching and learning from face-to-face to totally virtual. At the time of this study, campuses are still closed, thus leaving students to stay at home and learn through an online mode of delivery. The MCO was extended in four phases until early May 2020, followed by the implementation of the Conditional Movement Control order (CMCO) and then the Recovery Movement Control Order (RMCO), with less strict regulations, considering the decreasing trend of new COVID-19 cases. However, due to the emergence of new clusters and surging cases, the MCO was reinstated in selected states and then extended to the entire nation.[3] There were no physical classes due to the MCO imposed by the government. Local students were allowed to return to their homes. The international students had to stay put in their hostels/university accommodations. All classes were conducted online.
In this changing panorama of the COVID-19, the fear of contracting the infection coupled with anxiety around the ability to acquire the required knowledge and skills prevails.
There is a dearth of studies among medical students in Malaysia that assess the impact of the prolonged pandemic on various challenges faced by them on the academic, lifestyle, and social fronts.
In this study, we aim to investigate the impact of the prolonged COVID-19 pandemic on socio-psychological wellbeing, as well as the hardships and behaviors among Malaysian medical students.
| Subjects and Methods | | |
Study design and setting
An online, cross-sectional survey was conducted among undergraduate medicalstudents in Malaysia to assess their psychological wellbeing, difficulties faced in online learning, behavioral changes, and concern about the future. The study was conducted from November 2021 to January 2022 through Google forms sent to the medical students via WhatsApp messages. The sample size was calculated as follows:
n = Z2 × P × q/e2 = (1.96)2 × 0.5 × (1-0.5)/(0.05)2 = 384
In this formula, Z = 1.96 for confidence interval (CI) at 95%, P = prevalence 50% for maximum sample size, q = 1 - P and e = margin of error 5%. The minimum sample size was calculated to be 384.
Study instrument
A questionnaire was developed, adapting questions from previous studies and using expert opinions. The Zung's Self-rating Anxiety Scale (SAS)[4] is a 20-item self-report instrument that covers a variety of anxiety symptoms. The first five items in this instrument measure the psychological symptoms, including whether the respondent is nervous and anxious, feels afraid for no reason, gets upset and panicky, feels like falling apart, and thinks something bad is going to happen. Participants were asked whether they felt these symptoms more during the pandemic compared to before. For example, “I feel more nervous and anxious than I used to be before the COVID-19 pandemic.” The items were scored on a scale of 1 to 4; '1 = Never,' “ '2 = Sometimes,' '3 = Often,' and '4 = Always.' In the final analysis, the presence of psychological symptoms was assumed if they answered either 3 or 4 for at least one of the 5 items.
Six questions were asked to assess difficulties faced by the medical students in online learning. For example, for a statement: 'I find it difficult to focus on academic work' the students were asked to respond on a scale of 1 to 4: '1 = Not at all,' '2 = Sometimes,' '3 = Most of the time,' and '4 = All the time.' To assess behavioral changes during the pandemic, nine questions were asked: two questions on personal hygiene; two questions on following standard operating procedures (SOPs) during the pandemic; and four questions on a sedentary lifestyle. The students were asked about the frequencies of these practices, whether lesser than or more than usual during the pandemic. A single question was asked about how confident the medical students were with their clinical skills in the future. Demographic characteristics of the students included age, gender, year of study, and place of stay. The questionnaire was content validated by a panel of experts and pilot tested among 30 medical students.
Statistical analysis
Data were analyzed using the IBM Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corporation, Armonk, NY, USA). Quantitative variables were described as means and standard deviations, while qualitative variables were described as frequencies and percentages.
Ethical consideration
The study was approved by the Institutional Human Ethics committee of (HEC 2020/139). The respondents were informed of the purpose of the study and those who were willing to participate in the study were required to read and consent to participate in the study. Only upon consenting to participate, the respondents were allowed to continue the online survey. The participants were assured of the confidentiality of their responses.
| Results | | |
Demographic characteristics of study participants
The mean age of the 397 respondents was 20.9 ± 1.9 years. A majority (70.5%) were females; 39.0% were in year 2 and 81.1% stayed with their family members.
Psychological symptoms
The presence of psychological symptoms was assessed using the first five items in Zung's SAS. As shown in [Table 1], 82.9% of the respondents were more nervous and anxious during the pandemic compared to before.
Online learning
About 44% of the respondents had difficulty focusing on their academic work. About one-third had difficulties in adapting to online learning, experienced inadequate Wi-Fi connectivity, and faced difficulties completing assignments and tests on time. Similarly, about one-third had difficulties communicating with their classmates or lecturers [Table 2]. | Table 2: Difficulties faced in online learning by the participants (n=397)
Click here to view |
Behavioral changes
Assessment of selected behavioral changes during the pandemic compared to before its advent revealed that 38% of the respondents washed their hands more often and 43% bought more cleaning and hygiene supplies during the pandemic as compared to before. In line with the standard operating procedures (SOPs) issued by the Malaysian Ministry of health for the prevention and control of COVID-19, 42% of the respondents went out less often and 73% had lesser social contact, physically, with their friends [Table 3]. | Table 3: Behavioral changes adopted by participants during the pandemic (n=397)
Click here to view |
On a single question on how confident the medical students were with their clinical skills in the future, 235 (59%) responded that they were not confident at all.
| Discussion | | |
This study investigated the impact of the prolonged COVID-19 pandemic on the psychological well-being, as well as the hardships and behaviors among Malaysian medical students.
Psychological afflictions
In this study, 82.9% of the respondents were more nervous and anxious during this pandemic as compared to before. Similar findings were reported by Harries et al.[5] Contrary to our findings, Sundarasen et al.[6] found that only 29.9% of Malaysian university students experienced anxiety in the earlier stage of the pandemic. Saraswathi et al.[7] reported a significant increase in the prevalence of anxiety during the COVID-19 outbreak (33.2%) among Indian undergraduate students in an Indian medical college.
The timing of our study allowed us to capture a truly unique perspective of medical students during the prolonged pandemic period. Due to the pandemic, 48.4% of the students experienced increased anxiety and psychological symptoms. Studies conducted at the beginning of the pandemic reported a lesser prevalence of psychological symptoms.[7],[8]
Online learning
Forty-four percent of students reported difficulty focusing on their academic work. Our results concurred with the findings of a global survey conducted among HEIs.[9] About one-third of the respondents had difficulties in adapting to online learning and had experienced inadequate Wi-Fi connectivity. Studies from the Philippines and Pakistan reported that more than 50% of the participants had inconsistent internet connections affecting their learning.[10],[11] Around 29.2% of respondents in our study faced difficulties in the timely completion of assignments and tests. Adnan et al.[11] reported that 46.9% of the learners struggled with assignments and group projects. A third of our study participants also found it challenging to maintain effective communication with their classmates or lecturers. Similar findings were reported by Khalil et al.[12] in their study.
Fifty-nine percent of the respondents expressed that they lacked confidence in clinical skills due to a lack of exposure to real and simulated patients. Similar findings were reported in a study by Alsoufi et al.[13]
Behavioral changes
In our study, 38% of the respondents resorted to washing their hands more often as compared to before. These findings concur with the findings among Jordanian medical students and Turkish university students.[14],[15]
Compliance with the movement restriction and social isolation was observed in our study, wherein 42% of the respondents went out less often and 73% had lesser in-person interaction with their friends. Similar findings related to social isolation were reported by Sundarasen et al. and Akdeniz et al.[6],[15]
Fifty-five percent of students watched television more often and 45% engaged themselves in social media more often compared to before the pandemic. More than half of the participants exercised less frequently and this finding is in line with results from a study of Spanish medical students in the initial phase of lockdown.[16]
| Conclusion | | |
The COVID-19 pandemic has transformed our lives and health, but many lessons are yet to be comprehended. As more than 80% of the respondents are more anxious and nervous, the universities should provide emotional support to enhance the students' well-being. Most of the students have difficulty focusing on academic work, adapting to online learning, and inadequate Wi-Fi connectivity. Universities need to continually improve their infrastructure related to teaching and learning to encourage student engagement. The students have not adapted well to the rapid transition from face-to-face to online learning. Students have difficulty in communicating with peers and lecturers. What is concerning is that more than fifty percent of the respondents perceived that they lacked confidence in clinical skills due to a lack of exposure to real and simulated patients. In terms of a sedentary lifestyle, more than fifty percent of the students exercised lesser compared to pre-pandemic and about fifty percent snacked more than before. Adopting a healthy lifestyle is very important for the well-being of the medical students.
Limitation
The online nature of the survey limited the possibility of verifying the honesty with which the responses were provided.
Acknowledgements
The authors gratefully acknowledge the participation of all medical students in this study.
We hereby confirm that the manuscript has been read and approved by all the authors and the requirements for authorship have been met.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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