A total of 74 students completed the questionnaire, with 42 responses from MS1s, representing 40% of the MS1 class, and 32 responses from MS2s, representing 31% of the MS2 class.
Comparison of student perceptions of curricular satisfaction and interconnectedness
Overall satisfaction with the quality of the pre-clerkship education was comparable between the pre-pandemic MS2 class and the intra-pandemic MS1 class. 97% versus 95%, respectively, reported that they agreed or strongly agreed with the first survey question regarding satisfaction with the quality of the curriculum. However, a larger percentage of the MS2 class expressed strong satisfaction (41%) with the pre-clerkship curriculum as compared to the MS1 class (31%). 100% of students in both the pre- and intra-pandemic classes reported either being satisfied or strongly satisfied with the quality of the pre-clerkship Medical Physiology and Pathophysiology course. In addition, a similar proportion for students in both classes indicated that they either agreed or strongly agreed that the medical physiology course prepared them well for both USMLE Step 1 and third-year clinical rotations (Fig. 1).
At UCISOM, student perceptions of connectedness emerged as the most dramatic differences between the intra-pandemic MS1 class and the pre-pandemic MS2 class. Fewer students in the MS1 class agreed or strongly agreed that they felt connected with other members of their class as compared to the MS2 class (50% versus 94%, respectively). Following a similar trend, only 67% of the intra-pandemic MS1 class felt that they had a good support system with their peers, as compared to 94% of the pre-pandemic MS2 class. Unsurprisingly, the MS1s were less likely to agree or strongly agree that there were adequate opportunities to socially interact with other numbers of their class, with only 24% of the MS1 class agreeing or strongly agreeing that there were adequate opportunities as compared to 97% in the MS2 class. Likewise, only 31% of the MS1 class felt that they were connected with the faculty during the pandemic era as compared to 81% of the MS2 class during the pre-pandemic period (Fig. 2).
Comparison of student perceptions of institutional support and academic performance
Regarding student perceptions of institutional support from the School of Medicine, a large proportion of both MS1s and MS2s agreed or strongly agreed that there were adequate systems set up for students to express their thoughts and concerns (86% for the MS1 class versus 100% of the MS2 class). A similar proportion of students in each class felt that their opinions were listened to by the school administration, with 98% of the MS1 class and 97% of the MS2 class indicating that they either agreed or strongly agreed. Similarly, there was little difference between the MS1 and MS2 classes regarding perceptions of support from the school and awareness of mental health and wellness resources provided by the school. Importantly, 100% of the intra-pandemic class agreed or strongly agreed that they were aware of the available mental health resources (Fig. 3).
To evaluate student perceptions of their own academic performance, we compared survey responses between the pre-pandemic MS2 and intra-pandemic MS1 classes. 63% of MS2s agreed or strongly agreed that they had difficulty concentrating on their studies as compared to only 43% in the MS1 class. Overall, an equal portion of students in each class agreed or strongly agreed that they were performing optimally in their classes (66% for the MS1 class versus 60% for the MS2 class), regardless of in-person or virtual instruction. 91% of MS1s agreed or strongly agreed that course-provided lectures were necessary for passing class exams, with slightly fewer students (79%) agreeing or strongly agreeing with this in the pre-pandemic class. Lastly, virtual versus in-person education did not affect the amount of effort the students contributed to the end of course National Board of Medical Examiners (NBME) exam, with slightly over 50% of students agreeing or strongly agreeing that they tried their hardest in both the MS1 and MS2 classes (Fig. 4).
Utilization of third-party learning resources and communication software
While slightly more students in the MS1 class reported utilization of third-party learning resources compared to the MS2 class (62% versus 56%, respectively), fewer MS1s reported using third-party resources as their primary source of information compared to the MS2 class (7% versus 25%, respectively). Similar numbers of MS1s and MS2s report using third-party resources as a source of practice questions (Fig. 5). The classes differed in which resources they favored. The top three resources used by the MS1 class were First Aid (used by 36% of MS1 students), Board and Beyond (used by 36% of MS1 students), and ExamMaster (used by 31% of MS1 students). 29% of MS1s used Zanki (or another public Anki virtual flash card deck) decks for physiology review. Zanki/Anki decks, Boards and Beyond, and First Aid were the top three sources used by the MS2 class in 2019: 58% of MS2 students used Zanki/Anki, 53% used Boards and Beyond, and 28% used First Aid to study for the physiology course (Fig. 6).
Students the intra-pandemic curriculum utilized software to communicate with their classmates to a greater degree than students in the pre-pandemic curriculum. 93% of the MS1 class used software for communication regarding course content, compared to 59% in the MS2 class (Fig. 5). Preference for virtual communication software also differed among the MS1 and MS2 class. MS1 students primarily communicated via Slack (100%), Facebook (21%), email (2%) and texting (2%). MS2 students only reported using GroupMe (59%) and Facebook (50%).
Comparison of synchronous attendance and NBME exam performance
Self-reported attendance of non-mandatory live, synchronous physiology lectures was comparable between the MS1 and MS2 class. 36% of MS1 students and 41% of MS2 students reported attending the majority of physiology lectures (76-100% of lectures), while 19% of MS1 students and 22% of MS2 students reported only attending a few physiology lectures (1-25% of lectures). In both groups, 5-6% of students reported attending no live physiology lectures (Fig. 7).
The Medical Physiology and Pathophysiology course utilizes a customized Physiology NBME examination as a final exam that counts for 15% of the overall grade. The custom exam contains 75 questions pooled from the NBME question bank that are tailored to the topics emphasized in the course. The exam composition was identical for both the pre-pandemic MS2 class and the intra-pandemic MS1 class. The MS1 class scored significantly higher than the MS2 class on the Physiology NBME (p = 0.019, independent t test). The MS1 class average was 60.2% ± 8.9 (n = 104) in 2020, while the MS2 Physiology NBME class average was 56.8% ± 11.3 (n = 100) in 2019 (Fig. 8).
Challenges with remote learning
The majority of MS1 students reported that they encountered minimal barriers with regards to accessibility to the online physiology course material. 98% of students agreed or strongly agreed that the devices (iPad, computer, tablet, etc.) they used for remote education were adequate for learning the material. 79% of students agreed or strongly agreed that living with family/roommates did not overly distract from their remote education. 69% of students agreed or strongly agreed that the online format of remote education did not detract from their education. 90% of students reported that they had a quiet, comfortable place to attend class and to study, while 10% of MS1 students reported having financial difficulties obtaining a reliable Internet connection at home.
The MS1 class overall had a positive perception of varied teaching styles that were utilized during remote learning, despite concerns about its interactivity. Only 55% of MS1 students reported feeling the remote learning experience was interactive, though 91% reported being able to ask questions during remote lectures if needed. 98% of students reported that online instruction courses were flexible with their schedules.