Damian Sendler: For students of all ages, COVID-19 has revolutionized education. Preliminary data show that many levels of education have been lost and that anxiety and depression have risen as a result of the changes, but long-term outcomes are still unknown. Oversight organizations have moved quickly to provide guidance on the safety and efficacy of new educational delivery modalities. Increasing socioeconomic and special-needs gaps are not surprising. In addition to the many other professions whose training is based on internships, the medical field has also been severely impacted and has been forced to make significant adjustments.
Damian Jacob Sendler: When the coronavirus disease 2019 (COVID-19) pandemic occurs, students in elementary, middle, high, and professional schools may experience negative educational and health consequences as a result of switching to an online education. Age, maturity, and socioeconomic status all play a role in how these things play out. Oversight organizations have attempted to establish guidelines, expressed their concerns, and extrapolated from previous experiences. At this point in time, we have very little data on outcomes.
Dr. Sendler: Students’ mental, physical, and social health are all being studied by a slew of researchers, both to make up for any losses caused by the pandemic and to better prepare for similar events in the future. A lack of data at this point, but some researchers have drawn conclusions from previous school closures due to natural disasters.
Math grades in middle school are estimated to drop by 0.013 to 0.039 standard deviations when inclement weather and natural disaster closures are factored in, as are overall achievement scores.
2 Children who rely on school meals saw a greater drop in enrollment as a result of inclement weather closures, but the data were not stratified by socioeconomic status. 2, 3 All school closures have a greater impact on math scores than on English language scores. (4) and (5)
Assessments and professional development for educators are provided by the Northwest Evaluation Association (NEA). Since schools closed in March 2020, the average student has lost one-third to one-and-a-half to one-and-a-half years worth of learning in reading and more than one-and-half years in math, according to a study from Stanford University. 5
Families are dealing with new strains as school is no longer conducted in a traditional school building but rather online. It’s becoming more and more obvious that schools serve a much broader purpose than just teaching students how to read and write. Schools provide a wide range of services for students and their families, including food, shelter, health care, and social support. (5) and (6)
Because of the need for parents to stay at home with young children who are unable to go to school, many families have suffered from the loss of wages, resulting in food insecurity and housing insecurity.
6 People are showing signs of depression and anxiety because of the economic uncertainty. 7 Behavioral issues in children were blamed on the pandemic and virtual schooling by 34.71% of parents in one survey. 8
Coronavirus has infected and affected children. According to data from the Centers for Disease Control and Prevention, 42 percent of the 93,605 students tested positive for COVID-19 in the United States were Hispanic/Latino and 32 percent were non-Hispanic White. 9 The pandemic’s impact on children’s health goes far beyond the spread of COVID itself.. When schools go virtual, students from lower socioeconomic backgrounds suffer disproportionately because of the loss of on-campus health care and food services. However, school-based health care is the primary source of health care for many children and has left some chronic conditions unchecked during the pandemic, even though some districts were able to deliver school meals. 10
As a result of the panic caused by the pandemic, many parents report that their children’s diets have deteriorated, with an increase in sugary and fried foods.
12 and 11 Shelter at home orders and online education have resulted in fewer opportunities for exercise. It was found that the amount of time spent sitting had increased from 5 to 8 hours a day as a result of the lockdown conditions and stay-at-home initiatives implemented by Ammar and colleagues12. Because of the pandemic, there is growing evidence that diets high in sugar and fat may have a negative impact on cognition in both animal and human models. 13
The stress that the COVID-19 shutdown is causing families is of particular concern because of the growing body of evidence showing that adverse childhood experiences are linked to an increased risk of mental health problems in adulthood.
14 During the early pandemic school closures, there is evidence that children aged 6 to 18 years experienced an increase in their expression of “clinginess, irritability, and fear.” The stress caused by the pandemic may exacerbate the effects of these anxiety-related emotions on the family.
It’s also important to think about the long-term effects on children’s social skills of being isolated from their peers since the pandemic broke out. For many children, school is the place where they form their first social relationships and where their early social development takes place. 16 Children who have no access to resources may never recover, even into adulthood, because of the pandemic’s effect on their academic performance.
We can’t rely on the current state of the data to make exact predictions about school absence, summer vacations, and natural disasters, but what we do know is that not all children and adolescents will be equally impacted in the future.
(4) and (5) COVID-19 is expected to widen the already wide educational gap caused by socioeconomic differences, and children with learning differences are expected to suffer more losses than neurotypical children. Some children and adolescents may not experience any long-term consequences as a result of COVID-19.
Children with special needs have been particularly hard hit by the implementation of COVID-19, which has had ramifications across the educational spectrum. The Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act of 1973 provide legal protection for children with special needs in the United States to receive an appropriate education. 17 & 18 To ensure that “every child receives a free appropriate public education in the least restrictive environment,” this legislation provides for appropriate accommodations, services, modifications, and specialized academic instruction. 17
Applied behavior analysis (ABA) is a common educational strategy for children with autism. Therapy for autism uses discrete trial training, which shapes and rewards incremental changes toward new behaviors in a gradual manner. 19 A technique known as discrete trial training entails breaking down complex behaviors into smaller steps and rewarding the dog for making small progress toward those goals. When a child and therapist spend 20 to 40 hours per week together, it’s considered intensive one-on-one therapy. Children with autism benefit most from this therapy if it is started early and in the comfort of their own homes. 19
It was the responsibility and freedom of ABA providers to develop safety protocols for the delivery of this service in conjunction with certifying boards because ABA workers were regarded as essential workers in the early days of the pandemic.
Virtual visits and then in-home therapy with COVID-19 isolation precautions were used to supplement ABA during the early stages of the pandemic.
21 Virtual visits for ABA therapy appear to be less effective than in-person visits, but there are few outcomes data to support this. Because of the pandemic’s effect on therapist availability and the need to strike a balance between safety and efficacy, in-home services were quickly adopted. 21 The possibility of missing a window of opportunity to intervene early is a major concern for children with autism. Children and adolescents with autism spectrum disorder are more stressed than those with other disabilities before the pandemic, and the additional responsibility of monitoring in-home schooling during the pandemic has exacerbated this stress. 20
Anxiety-inducing and more difficult for adolescents with ADD/ADHD to adapt to virtual learning than their peers, according to early data on virtual schooling for children with ADD/ADHD.
22 In contrast, a study in Ireland found that younger children with ADD/ADHD and no other neurologic or psychiatric diagnoses who were stable on medication reported less anxiety with at-home schooling during the pandemic. 23 Children with attention deficit hyperactivity disorder (ADHD) may be able to identify these stressors when they are in a face-to-face school setting. Because of their additional diagnoses, children with ADD/ADHD were more likely to experience anxiety when their schools were closed. 24 and 23
Damian Jacob Markiewicz Sendler: In the absence of information on how to educate children with disabilities at home in the event of a pandemic, much of the literature available focuses on planning ahead. A recent report from the American Academy of Pediatrics warns that students who are diagnosed with ADHD but also have other conditions like learning differences, oppositional defiant disorder (ODD), or depression may have very different reactions to home schooling as a result of the non-ADHD diagnosis. For example, students with OD may refuse work or experience severe anxiety or depression. 25 The COVID-19 school closures have exacerbated already stressful situations for children and their families with learning differences.
During this pandemic, high school students have lost a lot. Shelter-in-place recommendations have thwarted what could have been a time of greater independence. It’s impossible to get back memories of graduations, formals, sporting events, college visits, and many other types of social and educational occasions that were ruined or destroyed.
Teenagers have reported higher rates of depression and anxiety due to the pandemic; in one study, 14.4% of teens reported PTSD, while 40.4% reported depression and anxiety.
26 During lockdown, adolescent boys reported a significant drop in life satisfaction from 92% before COVID to 72% during lockdown. The pandemic reduced adolescent girls’ life satisfaction from 81 percent before COVID to 62 percent during the pandemic, with the oldest teenage girls reporting the lowest levels of satisfaction. 27 When the schools were closed for COVID-19, 21% of boys and 27% of girls said that family arguments had gotten worse. 26 All of these reports, coupled with the fact that mental health services are becoming more difficult to obtain due to pandemic restrictions, make it difficult for parents to meet both their children’s mental health and educational needs.
Damian Sendler
During the pandemic, a study was conducted in Norway to examine how adolescents’ socialization and moods changed. Several phrases, such as “I comforted a friend yesterday,” “I tried my best to take care of a friend yesterday,” and “I sent a message to a friend yesterday,” were used to rate the likelihood of prosocial behavior on a scale of 1 (not at all) to 6 (very much). They also used a scale from 1 (not at all) to 5 (very well) to rate the degree to which various items reflected their current state of mind. 29 In the midst of the pandemic, they discovered that adolescents’ empathy and opportunity for prosocial behavior declined, as did their mood ratings. 29
Lesbian, gay, bisexual, transgender, and questioning sexual orientation (LGBTQ) youth are at an increased risk of suicide, according to a survey of 24,155 Michigan residents. This increase in domestic violence was also seen among LGBTQ youth who were receiving shelter. An additional group already at higher risk is the LGBTQ youth population, which has been hit hard by the pandemic.
The majority of teenagers now spend a significant amount of time in front of screens as a result of an increase in social media use and a shift to digital learning methods during COVID-19. Sedentary lifestyles, mental health issues and physical illness are all associated with excessive screen time. 31 It is more difficult to come up with simple solutions to the problem of screen time because of a lack of physical activity and an increased reliance on screen time for education in crowded inner-city areas.
Damien Sendler: For pediatricians, it’s more critical than ever to check in on the mental health of their patients with questions about how school is going, how patients are keeping in touch with their peers, and how they’re dealing with social issues related to violence. During this time of public emergency, it is necessary to ask families about their needs for assistance with hunger, housing insecurity, and access to mental health services.
In addition to the medical profession and our junior colleagues, medical school has been included because it affects all education that requires hands-on experience or internships.
To keep students and patients safe in the event of a pandemic, medical schools in the new COVID-19 era have been forced to make rapid and drastic changes to multiple levels of their curriculum. For students about to begin their clinical rotations, things have changed dramatically.
In high schools and colleges alike, COVID-19 has led to similar changes, such as the replacement of large in-person lectures with small group activities and virtual lectures.
32 Both students and faculty have been impacted by the rapid shift to an online format for medical education in the last few years. thirty-three and forty-four 33.3 percent of the 192 students who participated in a survey conducted by Singh and his colleagues during the pandemic found online lectures to be less effective than in-person classes. In another study by Shahrvini and colleagues35, 74.5 percent of the 104 students surveyed felt disconnected from their medical school and their peers and 43.3 percent felt unprepared for their clinical rotations. Since pre-COVID-19 data cannot be used as a benchmark, it is reasonable to assume that implementation of COVID-19 will increase clinical workers’ feelings of insecurity and underpreparedness.
In the medical school curriculum, gross anatomy is a well-established tradition that is conducted almost entirely in person and in close proximity to the body of the cadaver. According to a survey conducted by Harmon and colleagues36 of 67 gross anatomy educators, only 8% still used in-person sessions, while 34 43% turned to online cadaver images and dissection videos.
Damian Jacob Sendler
Because of the COVID-19 pandemic, many third- and fourth-year medical students have had their clinical rotations canceled or replaced with online learning, telemedicine, or virtual rounds.
Some 75 percent of medical schools have canceled clinical activities for third- and fourth-year students in 2020, according to an unofficial document from Reddit (a popular social network platform with a subgroup for medical students and residents). 93.7 percent of the 741 students who took part in the survey conducted by Harries and colleagues did not participate in clinical rotations that included direct patient contact. Seventy-five percent of students agreed with the decision, 34.7% felt guilty, and 27.0% felt relieved, according to the survey results. 39 A survey of 74.7 percent of students found that their medical education had been disrupted, 84.1 percent reported increased anxiety, and 83.4 percent stated that they would accept the risk of COVID-19 infection if they could return to the clinical environment. 39
It is imperative that medical schools find new and creative ways to teach and expose students to clinical settings since the outbreak of this pandemic. Continuing education has been greatly aided by the use of electronic conferencing services. Google Hangouts, for example, is a free online application that provides a wide range of tools for creating an integrated learning environment. A total of 32, 38, and 40 As a result, schools have begun using a hybrid approach to teaching, in which students can view prerecorded lectures at their convenience, followed by live virtual lectures where instructors can answer students’ questions about the material. With this new format, students have more control over their schedules, which may help alleviate some of their stress. 37
Medical training may benefit from some of these changes, despite the fact that students and faculty may find them difficult to implement. The American Medical Association and other programs have endorsed the value of telemedicine as a growing field. 41 It is still possible to conduct basic visual physical examinations and build rapport via telemedicine visits even in the event of a pandemic, and this will be beneficial to patients who are unable to travel to regular appointments due to the disease’s spread. Students can better prepare for a future in which telemedicine is expected and learn about the limitations and advantages of this modality by learning how to communicate professionally and conduct telemedicine visits now. 41
The process of applying to colleges, medical schools, and residency programs has been significantly altered as a result of the pandemic.
32 If the trend from 2016 to 2019 continues, 72% of those applying for US medical residencies will switch states or countries. 42 Because of the spread of COVID-19 and the lack of currently accepted procedures for safely executing such a large-scale migration, this level of movement is becoming increasingly hazardous.. Similarly, medical schools and universities are similarly impacted by this trend.
We need to accept and prepare for the fact that medical students and other learners who need in-person training may not have all of the skills they need when they begin their careers. These abilities will have to be learned at a later stage in the program. Our hospitals and other clinical professions may employ physicians and nurses with less experience and training than those at the entry level.
At all levels of education, the COVID-19 pandemic has affected and will continue to affect instruction. Although many children and adult learners will likely compensate for this interruption of traditional educational services and adapt to new modalities, some will struggle. Currently, there is no way to address the problem of those whose families lack the time and skills necessary to provide in-home education for their children. The COVID-19 pandemic school closures will have the greatest impact on students who are already at a disadvantage due to their socioeconomic status, language ability, or special needs. As pediatricians, it is imperative that we continue to check in with our young patients to see how they are coping and what resources are available in the community.
