“I feel very alone. Sure, I’ve met a few classmates on Zoom, but no one is close enough to truly be my friend. All I do is study, eat, sleep, and watch TV.
“If things were in person, I think I would’ve met people by now. I’d have a study group and we’d work together in the library or sit outside in the grass courtyard.”
— Anonymous note from a first-year student to the peer support team, Keck School of Medicine of the University of Southern California, January 2021
What is it like to attend medical school by yourself?
That’s how medical school feels for many first- and second-year students, as they live through conditions that have dragged on for nearly a year: rarely — if ever — setting foot on campus, joining online classes from the solitude of their rooms, and knowing their classmates and professors only as images on screens.
“The effect of isolation has been profound,” says Chantal Young, PhD, director of medical student wellness at Keck School of Medicine in Los Angeles.
Ever since medical schools sent students home in the spring of 2020 to prevent the spread of COVID-19, technology has helped to meet the challenges of virtual learning — but students’ social and emotional challenges are more difficult to assuage. The restrictions on gathering in person have left many students feeling deprived by the isolation from peers, instructors, and the physical space of school.
“More students are struggling,” says Guenevere Rae, PhD, assistant dean for basic science education at Tulane University School of Medicine in New Orleans. “They feel isolated, lonely, and more depressed.”
Schools and faculty are employing various strategies to help students cope, including social gatherings online, small in-person events on campus, and beefed-up wellness outreach and counseling.
To be sure, students are adjusting and plowing ahead. Those in their third and fourth years tend to feel less isolated, because they had established networks at school by the time the pandemic hit, and many have returned to clinical work. In contrast, today’s second-year students had their first year on campus cut short by COVID-19 shutdowns, and many of those who entered medical school last fall have never attended an in-person class.
“You learn medicine in community”
“I used to be a lecture-goer and I really enjoyed the social aspect of that. After class, you could go up to the professor and say, ‘This part of the lecture was really interesting and I have a question.’ Now when the [online] lecture shuts off, you lose that opportunity for a casual professional connection.”
— Natalie LaBossier, second-year student, Boston University School of Medicine
While students at all types of colleges are dealing with the social and emotional isolation brought on by COVID-19, medical students experience that isolation on top of the especially heavy pressures of medical school. The academic demands are so rigorous, the drive to excel is so intense, and the study hours are so long that it’s routine for students to work and worry to the point that their physical and mental health suffer. Medical students report higher rates of depression and suicidal ideation than the general population.
A critical key to relieving those pressures is working closely and forming bonds with other students and professors.
“They say you learn medicine in community,” says Jonathan Allotey, a first-year student at Tulane University.
Allotey hasn’t experienced much community since moving from Cleveland to an apartment near Tulane’s New Orleans campus, from which he joins class electronically. He knows what he’s missing: He learns better and forms friendships more easily by working closely with other students.
“I feel like I’m still a student in Ohio taking classes in New Orleans,” Allotey says.
Making connections with professors is also difficult through a laptop — robbing students of chances to bond with potential mentors and learn from them in ways that go beyond formal instruction.
“It’s nice to casually stop in” to a professor’s office to talk, says LaBossier, who attends Boston University from her family home in central New York state. “They do office hours on Zoom, but it’s not the same thing. I’ve never gone to Zoom office hours.”
Professors feel the impact as well. “The loss of connectivity has been a real challenge,” Rae says.
Spontaneity provides spark
“When school was going on normally, I was going to campus pretty much every day and spending most of my day there. When I lost that, it was a big disruption.
“Then it was just me going to lectures online, working out in my room, and hanging out there. It was a lot of alone time.”
— Christopher Lyons, Boston University School of Medicine
Lyons began medical school in fall 2019 and was doing fine before the switch to remote learning in spring 2020. He doesn’t miss sitting in a classroom; he misses the routine connections that made school his community.
“I very much enjoyed seeing my classmates in the library and cafeteria,” says Lyons, who lives 20 minutes from campus in an apartment with friends who are not in medical school. “Once the pandemic hit, I had a little bit of a hard adjustment to not being able to see everyone in person.”
Last spring, Lyons took a leave from school. He plans to return this fall.
Many students struggle with adjustment while remaining in school: Faculty have observed that the stress of COVID-19 isolation is showing in myriad ways.
“Those with any predisposition to anxiety or depression have seen worsening symptoms” during the pandemic, says Young, the director of medical student wellness at Keck School of Medicine.
She says the isolation has also worsened imposter syndrome — the feeling that you’re not cut out for this career — among some students, because they cannot easily do a “reality check” with peers to see that others also harbor self-doubt and that “you are not alone in the struggles.” As a result, more students are tapping into wellness supports to cope with those feelings.
“We have definitely seen an increase in appointments since the pandemic began,” says Cheryl Porter, PhD, assistant dean for student counseling at Florida State University (FSU) College of Medicine. The increase is not only due to more students seeking help, she says, but also requests for more frequent appointments.
At Tulane University, the director of student support and wellness had 95 official “student encounters” from August through December 2020 — a 65% increase over the same period in 2019.
Students are also helping each other less formally, such as through virtual get-togethers. But as LaBossier at Boston University notes, “every Zoom is a little inadequate compared to getting together in person,” and setting up casual gatherings online takes more work. Even the casual “who wants to grab a coffee after class?” has been replaced by a string of texts and emails that feels like scheduling a play date.
“If you can say, ‘Let’s do a potluck, everyone bring a dish and show up,’ that feels easier to organize,” says LaBossier, who organizes events as a leader of the campus Pride group. “Your priorities now are, ‘How am I going to figure out all the ways to make this [online meeting] work well?’”
Filling the voids
“One of our faculty members is a pretty good cook. She was talking about how you can eat healthy food at inexpensive grocery prices. She held a cooking class on Zoom, sent us a list: ‘Here’s what you’ll need to get.’
“It was a Mediterranean pasta dish. I’m no chef, but it was flavorful.”
— Daniel Alban, second-year student, FSU College of Medicine
Can professors and students alleviate the isolation induced by distance? They’re trying. Administrators say that students across the board have been eager to try wellness resources — such as Mental Health First Aid courses and Headspace subscriptions — and join activities to help them cope. Among the strategies:
Increase communication: Going virtual cuts off the flow of information that occurs organically among people as they interact on campus. A few weeks into last fall’s semester, “students were complaining that they felt out of touch with the administration,” notes Rae at Tulane University. “They wanted to meet regularly with the administration and ask about anything that was on their minds.”
The administrators now meet weekly with a group of student leaders representing each class. Rae says the students’ questions are primarily about logistics, like COVID-19 vaccination opportunities and exam schedules.
Create social events: Stanford University School of Medicine provided paint, brushes, and canvases for students to take home and join a virtual paint party online. The University of Chicago Pritzker School of Medicine holds online story slams; Wei Wei Lee, MD, MPH, associate dean of professional development and engagement, recalls one focused on faculty “talking about times they screwed up.”
Gather in person: Several schools have invited groups of students to campus in waves for socially-distanced receptions with faculty. At Tulane University, faculty and student leaders established a walking club, with up to 10 people at a time strolling on campus and in city parks. A faculty member leads the way, but Rae says the students primarily talk with each other, then build ongoing relationships from those conversations. Vaccinations of students and staff are enabling schools to phase-in more campus activities, including some in-person class attendance.
Open parts of campus: Some schools allow small groups of students to assemble on campus, either outside or in designated rooms, primarily for study groups. Indiana University School of Medicine in Indianapolis requires students to get faculty approval first. FSU College of Medicine set up a check-in process in which staff provide students with cleaning supplies along with distancing and masking protocols.
Organizing fellow students: A Tulane University student recruited 20 classmates to an escape room challenge online, Allotey says. At FSU College of Medicine, Alban regularly sends a group email inviting students to join him in a study group on Zoom. The cameras stay on but sometimes they all work in silence for a while. Part of the value, Alban says, is simply being present to keep each other on task and ask questions when needed.
Some efforts are even more targeted: Also at Tulane University, a student invited Allotey and two others to meet for a socially distanced coffee on a Sunday morning. His initial nervousness over the stiffness of the arrangement quickly faded to enjoyment over a relaxed moment with peers. “I didn’t realize how much I was missing that kind of environment,” Allotey says.
Check on wellness: Schools are upping the outreach of their student leadership groups and wellness programs to ask students how they’re doing and offer resources to help. At Keck School of Medicine, Young says staff nudge students to “push out of their comfort zone” for social engagement by asking such questions as, “Have you signed up for the online coffee chats? Have you followed up with the person you met? How many times per week are you actually going outside?”
Faculty at Indiana University created “connection communities” where up to a dozen students meet online with professors and upperclassmen “to talk about where they are rather than what they’re studying,” says Antwione Haywood, PhD, assistant dean for medical student education. He says the sessions include stress reduction strategies.
The peer support group at Keck School of Medicine — where the first-year student sent the note in January about having no friends — prompted this response from a fellow first-year student:
“I am sorry to hear you have been feeling alone. I think it is important to remind ourselves that many in our class feel this way. ... The fact that this is a shared experience makes me hopeful that once life returns to normal, there will be many ready to meet others and make friends.
“One thing that may be helpful is reaching out to friends from outside med school. This year has been rough, and we shouldn’t forget the social support we may already have.”