Table 3 (Sub-)Themes in personal experiences of COVID-19 impact on studying and internship

Theme 1. Job-study demands

 Subtheme: Increased workload (general)

29

3

“I work at emergency care and the work here is hard. It’s 6/7 days with quite long hours. Leaving home at 6.30AM to arrive home at 7PM” (COVID care, male, intern)

 Subtheme: Lack of adjustment of requirements to changed context

8

6

“The workload has not been adjusted by the faculty and the on-call duties for COVID nevertheless have to be guaranteed” (COVID care, female, intern)

 Subtheme: More time-intensive, everything takes longer

4

2

“Everything is slowed down, we must constantly remind those involved (e.g. lab heads) that we were waiting for their help as agreed … It is very time consuming, while we are all running out of time!” (non-COVID care, female, intern)

 Subtheme: Having to be constantly available

4

0

“In terms of hours, these increased slightly but not unreasonably so. It is however this need to be constantly available that is exhausting” (COVID care, female, resident)

 Subtheme: Need for constant adaptation in changing context

5

0

“The constant adaptation is exhausting ” (COVID care, female, student)

 Subtheme: Difficulties when studying at home (interference, independent, technical problems)

8

4

“While some, who are used to studying in the library, are now obliged to do so from home, sometimes with little brothers and sisters to watch over as the parents have to work” (COVID care, female, intern)

 Subtheme: Changes in how teaching/exams takes place

12

5

“Lack of internship, lack of practice. A decrease in various consultations. Less technical acts. Permanent stress and tangible tension” (non-COVID care, female, intern)

 Subtheme: More responsibility when on call at internship

3

1

“More responsibilities during on-call” (COVID care, female, intern)

 Subtheme: Change of work content (all focused on COVID-19)

8

3

“It disrupted our “normal” learning. It slowed down all services except emergencies and covid units preventing those in surgery, dermatology, etc. for example to learn from their internships” (non-COVID care, female, intern)

 Subtheme: less direct patient contact, teleconsultation and lack of follow up (transformation of care)

29

6

“Telephone contacts all day long to “sort out” patients: dehumanization, anxiety, fear of not being up to the task by telephone” (COVID care, female, resident)

THEME 2: LACK OF RESOURCES

 Subtheme: Lack of emotional support by university instances

11

4

“The faculties did nothing for us except postpone the submission date. Oral defences and exams are maintained with no reduction in material to learn. No discussion possible with them. No empathy. We are treated like beasts” (non-COVID care, female, student)

 Subtheme: Lack of respect (from supervisors, university, patients)

7

2

“This situation was a hard blow for me morally because I had volunteered to help with the conviction that the faculty authorities, made up of caregivers, would understand the situation and would value it by being understanding and indulgent. Almost no understanding was received, however (other than a “benevolent indulgence” for oral evaluations)” (non-COVID care, male, intern)

 Subtheme: Promotors who are not available for supervision (sick, exhaustion)

5

0

“Our supervisors have relatives with coronavirus and no longer have the desire or the energy to help us … We feel alone and abandoned in this process when we need them most” (COVID care, female, intern)

 Subtheme: No possibility to unwind (relax, no holidays)

5

0

“Very little time to rest” (COVID care, female, resident)

Subtheme: Fewer learning opportunities

6

8

“Required in the covid units = more important and less instructive work than when we are in a classic internship (therefore “waste of time” from a learning point of view)” (non-COVID care, female, student)

 Subtheme: Important aspects of education (temporarily) cancelled

29

25

“Three internships of one month each were cancelled” (COVID care, male, student)

 Subtheme: Administrative or nursing work instead of learning as medical intern / redundant work

11

2

“The trainees are not used as interns in medicine but as a secretary / nurse / help in caretaking ” (non-COVID care, female, student)

 Subtheme: Non-functioning or unavailable material during care

3

0

“Logistical problems: a single scanner available for all emergencies considered covid including dyspnoea, chest pain and temperature regardless of the context, laboratory slowed down for hygiene reasons, time wasted trying to convince the floors to hospitalize a person because they are all afraid of the covid … Lack of rooms and nursing staff: all treatment is slowed down and patients keep accumulating” (COVID care, female, resident)

 Subtheme: Considering certain parts of the training or the job irrelevant or absurd

3

0

“Emotionally, it’s very difficult to stay at home to work on absurd things like the master thesis, while the medical profession is in distress and we are asked to come and help, every day.” (COVID care, female, intern)

THEME 3: RESOURCES

 Subtheme: Positive opportunity to have more time to study due to cancellations of certain tasks

8

2

“We were therefore able to study for our exams without stress and do our research for the thesis and for our group work.” (non-COVID care, female, student)

 Subtheme: No change, all is maintained via digital means

3

1

“Identical: personal exercises and exams maintained via Teams and online questionnaires ” (COVID care, female, intern)

 Subtheme: Volunteering (general)

27

9

“Less internship activity but compensated by volunteering activity” (non-COVID care, male, intern)

 Subtheme: Reduced workload in non-COVID-19 care

11

2

“Either heavy workload in the units concerned, or lack of work everywhere else” (COVID care, male, intern)

THEME 4. STRAIN

 Subtheme: Psychological distress (general)

13

3

“The psychological stress associated with the epidemic greatly increases the workload because it is about working against one’s own best interest when caring for these patients” (COVID care, female, resident)

 Subtheme: Stress related to having to combine everything

12

4

“Students are asked to help in COVID units and this takes time, knowing that we also need to work on our master thesis and final exams that have not been cancelled”(non-COVID care, female, student)

 Subtheme: General stress in relation to COVID-19 (impact on family, environment at work)

11

5

“The workload is not too much of the problem. Rather, it's the emotional load, the environment of constant anxiety, not seeing friends and losing my mind, that tires me at the moment” (non-COVID care, female, resident)

 Subtheme: Uncertainty

6

6

“We have to deal more with the unexpected than when our days are already well organized in advance” (COVID care, female, resident)

 Subtheme: Fatigue, exhausting

5

1

“It affects my morale and therefore my impression of having to give all my energy to perform simple tasks” (COVID care, female, student)

 Subtheme: Loneliness, missing social contact

2

4

“To not see your mates during a long time makes you lose your energy” (non-COVID care, female, student)

 Subtheme: Feeling of being powerless, lack of control, no perspective of improvement

4

0

“Psychological burden +  +  + because high mortality and powerlessness” (COVID care, male, student)

 Subtheme: Feeling of not being allowed/supposed to complain

2

1

“Not ideal, but nothing to complain about either ” (COVID care, male, student)

 Subtheme: Lack of motivation to study, cannot concentrate

6

3

“I was much less motivated to study, and the various adjustments it caused were very stressful” (non-COVID care, female, student)

 Subtheme: General stress facing patients

10

1

“It is also necessary to manage the stress of patients, reassuring them is energy consuming” (COVID care, female, resident)