ABSTRACT
BACKGROUND: The COVID-19 pandemic has revealed challenges that medical students face when healthcare systems are under intense pressure. There is a need to assess medical students' education needs in pandemic preparedness. The objective of this mixed-methods study was threefold: (1) to assess COVID-19 perceived efficacy, susceptibility, and anxiety in relation to health literacy; (2) to describe attitudes towards a policy of precautionary measures against COVID-19 and willingness to work during an outbreak; and (3) to examine multilevel factors associated with willingness to work. METHODS: An online survey was conducted among 263 medical students in Singapore during the lockdown period in July 2020. Participants were surveyed on COVID-19 related literacy, perceptions, anxiety, attitudes towards a policy of precautionary measures, and willingness to work during an outbreak. Bivariate and multivariate analyses were used to determine the factors associated with the key outcome variable of willingness to work. In addition, open-ended questions were used to assess medical education needs, which were reported using thematic analysis. RESULTS: Perceived adequacy of COVID-19 information was associated with higher perceived efficacy, lower perceived susceptibility, and lower anxiety levels among the students. Medical students were mostly supportive of COVID-19 precautionary measures except for relatively intrusive measures like in-home surveillance. The degree of willingness to work during an outbreak varied based on certain conditions, in particular family's health and safety, and was associated with self-efficacy, perceived susceptibility, and hospital capacity of outbreak management. CONCLUSIONS: Medical students' attitudes towards a policy of precautionary measures varied depending on legality, financial and psychological support, and privacy concerns. Health literacy played an important role in increasing the efficacy of protection against COVID-19 and reducing pandemic-related anxiety among medical students. Their willingness to work during an outbreak was increased by an effective policy of precautionary measures, hospital capacity to manage a pandemic, and assurance of family safety. Medical education should include pandemic preparedness to better prepare students to aid in pandemics, with emphasis on public health policy and ethics coupled with clinical training targeted to managing outbreaks.