HOW DID THE COVID-19 PANDEMIC IMPACT MEDICAL STUDENTS FROM LOW- VS. HIGHER- SOCIOECONOMIC STATUS BACKGROUNDS? A MULTICENTER U.S. SURVEY STUDY

ABSTRACT

BACKGROUND:Medical schools' efforts to enhance student diversity often focus on increasing representation and support for visible identities (e.g., race or gender), while efforts to enhance diversity of invisible identities, such as socioeconomic status (SES), have been more limited. While the research on experiences of low-SES medical students remains limited, early studies have found that low-SES students experience barriers completing medical school, and it is unknown whether these experiences were exacerbated by the COVID- 19 pandemic. We aim to understand how the pandemic impacted medical students from low-SES as compared to higher-SES backgrounds. METHODS: Students from 14 U.S. medical schools were surveyed March- May 2021 using an 88-item electronic questionnaire, which assessed students' pandemic experiences, SES status and wellbeing using validated tools, multiple choice and open-ended questions. Because no single low-SES measure is universally accepted, students who met the criteria for any of the following three measures were considered low-SES AAMC Employment-Occupation SES- disadvantaged indicator, bottom 2 quintiles of household income during childhood, and/or self-classification as low- SES. Low-SES students' responses were compared to higher-SES peers. Standard descriptive statistics, Chi-squared tests, and multivariable generalized estimating equation models adjusting for confounding covariates were used, and analysis was conducted in R 3.6.1. RESULTS: Of 6,836 eligible students,1,555 (22.7%) responded. Compared to their higher-SES peers, low-SES students were more likely to report difficulty accessing adequate resources for remote learning [Odds Ratio (OR) 1.44 (1.14- 1.81), p=0.014], difficulty with affording basic needs during the pandemic [OR 7.64 (3.85-15.16), p<0.001], the need to take out more loans to support themselves or their families [OR 2.68 (2.04-3.53), p<0.001], the need to seek employment to support themselves or their families [OR 2.40 (1.56-3.70), p<0.001], and loss of employment by one or more of their parents or guardians [OR 2.45 (1.58-3.81), p<0.001]. Low-SES students were also more likely to report that financial concerns were one of their top 3 worries during the COVID-19 pandemic [OR 4.06 (2.71-6.06), p<0.001]. There was no difference between low- and higher-SES students' satisfaction with their school's response to the pandemic with regards to support for students experiencing financial strain (p=1.00). CONCLUSIONS: In this multi-school U.S. survey study, we demonstrated that low-SES medical students experienced more challenges related to the COVID-19 pandemic when compared to their higher-SES peers. Our findings can be used to guide interventions to better support low-SES medical students and promote socioeconomic diversity in medicine. More research is needed to better identify the needs of low-SES students and determine key areas for support.