Hopelessness among Medical Students Caused Due to COVID-19 Pandemic Linked Educational Hiatus: A Case Study of Bursa Uludag University, Türkiye
by
, and
Mevlut Okan Aydin
1
,
Guven Ozkaya
2,
Ilker Mustafa Kafa
3,
Shafiul Haque
4,5,6,*
and
Zuleyha Alper
1,* 1
Department of Medical Education, Faculty of Medicine, Bursa Uludağ University, Bursa 16059, Türkiye
2
Department of Biostatistics, Faculty of Medicine, Bursa Uludağ University, Bursa 16059, Türkiye
3
Department of Anatomy, Faculty of Medicine, Bursa Uludağ University, Bursa 16059, Türkiye
4
Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan 45142, Saudi Arabia
5
Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut 1102 2801, Lebanon
6
Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
*
Authors to whom correspondence should be addressed.
Sustainability 2023, 15(4), 3049; https://doi.org/10.3390/su15043049
Submission received: 16 December 2022
/
Revised: 23 January 2023
/
Accepted: 28 January 2023
/
Published: 8 February 2023
(This article belongs to the Special Issue Mental Health of People during COVID-19 and Beyond: The Situation, Adaptation, and Sustainability)
Abstract
:The COVID-19 pandemic has caused disruptions in medical education, leading to feelings of hopelessness among students regarding their medical careers. However, effective institutional crisis-response approaches can mitigate these feelings of hopelessness. This study evaluated changes in the levels of hopelessness among Turkish medical students due to interruptions in their education caused by the pandemic between March and July 2020, using the Beck Hopelessness Scale in three selected periods. A statistical survey was conducted with a total of 3580 participants in three different periods to study the impact of various contributing factors, such as socio-economic status, family problems, health problems, and lack of working environment, on the levels of hopelessness in conjunction with active COVID-19 cases and the effect of institutional interventions for the continuation of medical education during the pandemic. The analysis revealed a direct relationship between contributing factors and hopelessness scores at the end of the selected three periods. Additionally, active COVID-19 cases and institutional crisis-response strategies were found to be indirectly associated with students’ hopelessness. An increase in students’ hopelessness was found to be related to an increase in active COVID-19 cases in the country, a lack of continuing education practices, and the role of contributing factors. Conversely, a decrease in hopelessness was associated with effective institutional crisis-response strategies. These findings suggest that educational settings dealing with practical subjects should prioritize preparedness for crisis situations.
1. Introduction
The ongoing COVID-19 pandemic has had a significant impact on the education system worldwide, with university education being no exception. Despite progress in vaccination, the emergence of new variants has continued to disrupt the learning process. Educators in many countries are still grappling with the sudden shift to digitalization. Medical students, in particular, are facing uncertainty and anxiety about their future clinical exposure, which has been severely compromised. Medical schools, like all other educational institutions, have implemented innovative educational transformation techniques to shift to online learning and assessments, while providing effective solutions for the partly disrupted education during this pandemic. It is well-known that pandemics, such as COVID-19, can cause environmental stress, problems with human nourishment, shelter, and basic needs. The dynamic nature of the epidemic and the contagiousness of the viral agent have led to diverse psychological conditions among the population as a result of stress, greatly impacting society’s mental health [1]. During such times, fear of illness or quarantine, along with associated social and economic problems, have led to increased anxiety and depression symptoms among individuals. Additionally, feelings of helplessness and inability to manage other psychological problems have been exacerbated by the COVID-19 pandemic [1,2,3,4,5,6,7,8].
Previous research has shown that medical students experience higher levels of anxiety, stress, depression, fatigue, burnout, and other mental health issues due to the demanding nature of medical education. In terms of mental health, these medical students may encounter different pathological conditions during their medical education, despite starting out in good health. Furthermore, it is expected that the uncertainty caused by the COVID-19 pandemic in terms of the resumption of normal education may increase students’ levels of hopelessness [9,10]. In this study, we aim to explore the factors that play a significant role in developing various degrees of hopelessness among medical students, which ultimately has a direct impact on students’ academic success or, in the worst case, can affect their medical careers.
Beck et al. have defined hopelessness as a situation in which a person perceives their present, future, and the outside world in a negative manner [11]. Environmental stressors, such as pandemics, are thought to trigger hopelessness, which can include symptoms of both depression and anxiety [11]. In this context, the present study was performed aiming to explore the pandemic-response controlling factors impacting medical students’ hopelessness and their possible impact on students’ professional medicine career. The hypotheses of this study are as follows: (a) unusual conditions, such as a pandemic that disrupts formal education and creates uncertainty about the future, have an impact on students’ feelings of hopelessness; (b) socioeconomic status, family problems, and working environment all have an impact on students’ feelings of hopelessness; and (c) uncertainty in educational processes and/or institutional crisis-response strategies might influence students’ feelings of hopelessness.
The present study aims to explore the factors that contribute to feelings of hopelessness among medical students during the COVID-19 pandemic, including socioeconomic status, family problems, health issues, and inadequate working environments, and their impact on academic success. Additionally, the study aims to evaluate the impact of institutional crisis-response strategies on feelings of hopelessness among medical students in Türkiye, in order to maintain continuity in medical education.
2. Materials and Methods
2.1. Subject Details
The present study is a cross-sectional survey-based study conducted by the faculty members of Bursa Uludağ University Faculty of Medicine (BUUFM) Department of Medical Education. The study population consisted of Grade 1–5 students (n = 1916) from Bursa Uludağ University Faculty of Medicine who volunteered to fill out the questionnaire.
2.2. Background Information
2.2.1. Medical Education at Bursa Uludağ University before the COVID-19 Pandemic
The BUUFM Undergraduate Education Program is a 6-year program consisting of three phases. Phase 1 covers a pre-clinical education period of the first three grades. Phase 2 includes the clinical education period of the 4th and 5th grades. Phase 3 includes the 6th grade and involves the family medicine/internship period, which lasts for a year and allows students to take a more active role in clinical procedures after successful completion of the first two stages.
2.2.2. Medical Education at Bursa Uludağ University, during COVID-19 Pandemic
The COVID-19 pandemic has had a significant impact on medical education at Bursa Uludağ University. Following the first reported case in Türkiye on 10 March 2020, classroom instruction was suspended for three weeks across all universities in the country. The Council of Higher Education (CoHE) subsequently implemented synchronous or asynchronous distance education methods, in accordance with local isolation rules and university capabilities. In response to these developments, the University’s “BUUFM Good Medical Practices and Simulation Center” (USIM) focused on developing infrastructure and technical support for synchronous online courses. Additionally, the university’s education and research management system, “UKEY”, was utilized more frequently for asynchronous access to spring semester course content.
In order to assess the effects of these changes on students, an online survey entitled “Medical Education Process Under Pandemic—1, 2, and 3” was administered periodically to examine students’ experiences and the challenges they faced with distance education. These surveys were announced on the university’s medical faculty’s web pages and social networks through student representatives.
This study was divided into three periods based on institutional crisis-response strategies that were in place at the time. The first period, referred to as the “silent period”, focused on meetings and planning, and lasted until 28 March 2020, when asynchronous training began. During the second period, referred to as the “proactive period”, all necessary preparations for synchronous and asynchronous training were made until 28 April. The final period, referred to as the “active period”, ended on 7 July 2020, during which synchronous training applications and online evaluations were conducted.
The study was conducted using a voluntary survey questionnaire distributed among medical students via Google Forms on the last days of each of the three periods (28 March, 28 April, 7 July 2020). The questionnaire consisted of multiple-choice questions, including demographic information such as gender and grade level, as well as other factors that may have an impact on the educational process.
2.3. COVID-19 Positive Status for Himself/Herself or His/Her Close Relatives and Its Effect on the Level of Hopelessness
The second part of the survey involved administering the Beck Hopelessness Scale (BHS) to assess the effect of a COVID-19 positive status for the participant or their close relatives on the level of hopelessness [11]. At the beginning of the questionnaire, the aims and objectives were clearly explained to all the participants. Participants’ informed consent was obtained and students’ filled-out forms were included in the study.
2.4. Beck Hopelessness Scale
The BHS is a tool developed by Beck et al. (1974) for determining an individual’s negative expectations or thinking about the future. Turkish validity and reliability studies have been conducted for the BHS and its translation into Turkish [12,13]. The scale consists of 20 items, with seven of them scored negatively (1, 5, 6, 8, 13, 15, and 19), where a score of 4 and above is considered as a “hopeless” condition. The total score ranges from 0 to 20, with higher scores indicating higher levels of hopelessness.
Scores ranging between 4 to 8 reflect mild hopelessness, while scores ranging between 9 to 14 and 15 to 20 indicate moderate and severe levels of hopelessness, respectively. The original version exhibited a 3-factor structure, i.e., “feelings about the future”; “loss of motivation”; “future expectations” [13]. The total score ranges from 0 to 20, with higher levels of hopelessness indicated by higher scores on the scale. The studies wherein BHS has been applied, a score of 4 and above is considered as “hopeless” condition [14].
2.5. Statistical Analysis
The statistical analysis results were presented as mean ± standard deviation (SD) or frequency and percentage. Normally distributed data were compared with independent samples’ t-test or one-way ANOVA. The Bonferroni test was used as multiple comparison test. Categorical variables were compared using Pearson’s chi-square test and Fisher’s exact test between groups. The factors affecting BHS were examined by binary logistic regression analysis. The statistical significance level was maintained as p < 0.05. All the statistical analyses were performed using IBM SPSS ver. 23.0 (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY, USA: IBM Corp.) program.
3. Results
The survey questionnaire was administered to all the students (n = 1916) of Bursa Uludağ University Faculty of Medicine, with the exception of Grade 6 students, on the last days of three distinct periods, 28 March, 28 April, and 7 July 2020, referred to as silent, proactive, and active periods, with n1 = 1419 (73.8%), n2 = 1535 (79.8%), and n3 = 626 (32.6%) participants, respectively. The percentage distribution of the students according to their grades, Grade 1–Grade 5 (G1–G5), was 24.2%, 22.1%, 17.8%, 17.9%, and 17.9%, respectively (Figure 1). The distribution of female to male students was 53.7% to 46.3%, respectively (Table 1).
Approximately half (50%) of the participants responded that various factors affected their education process to different extents, such as inadequate working environment for 36.3%, financial difficulties for 15.2%, family problems for 13.4%, health problems for 9.1%, and housing problems for 2.2% (Table 1).
A statistically significant difference was found between the silent, proactive, and active periods in BHS total and sub-factor scores, which were further used to measure the effect of the students participating in the study on “loss of motivation”, “feelings about the future”, and “future expectations” (p < 0.001). The scores measured in the proactive period were found to be higher than the scores in the silent and active periods (Table 2). The BHS total score was found to be higher in female students compared to male counterparts.
3.1. Comparison of BHS Total and Sub-Factor Scores Applied in three Periods by Grades
Kindly refer to Table 3, Figure 2, Figure 3, Figure 4 and Figure 5, and Supplementary Information: Tables S1 and S2.
Comparison of BHS total and sub-factor scores applied in the three periods by grade level showed that a statistically significant difference was observed between the three measurements in Grade 1 (G1) students in terms of “loss of motivation” sub-factor (p < 0.001). The “loss of motivation” score measured in the proactive period was higher than the scores in the silent and active periods. Additionally, a statistically significant difference was found between the three different period measurements in G1 students in terms of BHS total score (p = 0.002), with the BHS total score measured in the proactive period being higher than the scores in the silent and active periods.
Similarly, in Grade 2 (G2) students, a statistically significant difference was found between the three different period measurements in terms of the “loss of motivation” sub-factor (p < 0.001), with the score measured in the proactive period being higher than the scores in the silent and active periods. Additionally, a statistically significant difference was observed between the three-period measurements in G2 students in terms of BHS total score (p < 0.001), with the BHS total score measured in the proactive period being greater than the scores in the silent and active periods.
In Grade 3 (G3) students, a statistically significant difference was found between the three different period measurements in terms of the “loss of motivation” sub-factor (p < 0.001), with the score measured in the proactive period being more than the scores in the silent and active periods. Additionally, a statistically significant difference was calculated between the three different period measurements in G3 students in terms of BHS total score (p < 0.001), with the BHS total score measured in the proactive period being higher than the scores in the silent and active periods.
In Grade 4 and Grade 5 (G4 and G5) students, a statistically significant difference was found between the three different period measurements in terms of the “loss of motivation” sub-factor (p < 0.05), with the score measured in the proactive period being higher than the score measured in the silent period. However, there was no statistically significant difference observed in terms of BHS total score and other sub-factors. No statistically significant difference was observed in terms of BHS total score and other sub-factors.
3.2. Inter-Period Comparison of BHS Total and Sub-Factor Scores in Silent, Proactive, and Active Periods
The results of this study indicate that there was a statistically significant difference in the “future expectations” score between Grade 1 and Grade 4 students during the silent period. Additionally, the “feelings about the future” score of Grade 4 students was found to be higher than that of Grade 1 and Grade 2 students during the same period. Furthermore, during the proactive period, there was a statistically significant difference in the “feelings about the future” and BHS total scores between Grade 1 and Grade 4 students, with Grade 4 students having higher scores. In the active period, there was a statistically significant difference in BHS total scores between Grade 1 and Grade 4 students, with Grade 4 students again having higher scores (Table 3).
3.3. Evaluation of BHS Scores of Factors Affecting the Education Process in Three Periods
In summary, the study found that students experienced higher levels of hopelessness in the proactive period, particularly in terms of loss of motivation and future expectations. Factors such as a lack of working environment and family problems were found to be significantly related to hopelessness, while financial distress, housing problems, and health problems were not found to be significant. When excluding students who reported a lack of working environment and family problems, the study found a statistically significant difference between the three periods in terms of BHS total score, loss of motivation, and future expectations, but not in terms of feelings about the future. Additionally, the study found that the loss of motivation score was found to be significantly higher in the second period, and a significant decrease was observed in the third period (Table 4, Table 5 and Table 6). It appears that the study found that the detection of COVID-19 in a student’s family or surrounding neighbors did not have a significant impact on their level of hopelessness, as measured by the Beck Hopelessness Scale, during the three periods of the study (Table 6).
4. Discussion
The COVID-19 pandemic has disrupted every aspect of our lives since the beginning of 2020 and continues to do so with the emergence of new SARS-CoV-2 variants. Similarly, to other educational streams and levels, the pandemic has presented medical students with an undesirable interruption in their education and clinical training. In response, medical educators, like others, have opted for a sudden transition to digitalization. Some faculties continued their education using their usual approach, while others limited student participation in clinical training, graduated students early and allowed them to work in the field, or fully adopted social distancing principles and switched to online pedagogy. Institutions with well-integrated online teaching facilities were generally able to adapt to this situation by changing their teaching techniques. However, this process was challenging for institutions without such facilities. Additionally, medical students faced challenges related to mental and emotional problems, such as stress, anxiety, and fear associated with the current education process and its impact on their future medical careers [15,16].
Different countries have employed various education and teaching approaches to cope with the pandemic era and maintain continuity in medical sciences education. In Türkiye, the recommendations of the Council of Higher Education and the Ministry of Health Science Board have guided and encouraged medical faculties to develop suitable action plans to tackle this critical situation. Following the suspension of education throughout the country on 13 March 2020, the education-related committees of BUUFM developed contingency plans [17].
This study aims to evaluate the changes in the levels of hopelessness among students at BUUFM who experienced interruptions in their education due to the extraordinary circumstances of the COVID-19 pandemic between March 2020 and July 2020, using the Beck Hopelessness Scale in three different periods determined by the plans and practices implemented. Additionally, the study aims to identify the factors that directly and indirectly affect these changes. The survey data revealed that socioeconomic status, family problems, health-related issues, the presence of individuals with COVID-19 positive status in the family or surroundings, and inadequacy of the working environment were the major factors that had an impact on the mental health of the students. The changes in COVID-19 cases and institutional crisis-response strategies for medical education were evaluated as indirect factors. The relationship between the direct factors and hopelessness scores measured at the end of the selected three periods was also investigated.
The study was conducted with a total of 3580 participants, n1 = 1419, n2 = 1535, n3 = 626, respectively, in three different periods. The participation rates of the students in the different grades were similar. However, the students’ participation in the survey applied in the three periods decreased significantly in the third evaluation period, which could be explained by the term “survey fatigue” among the students [18]. In different studies conducted during the pandemic, certain sociodemographic characteristics have been found to affect depression levels. Similar to the current study, recent reports have shown that being female, a student, and young are risk factors for depression [19,20]. The general scores of the Beck Hopelessness Scale were found to be higher in female students, which is consistent with published literature (See the Supplement File, Table S2).
In an article investigating the impact of the pandemic on the mental health of higher education students in the USA, a majority of the participants (n = 1443, 71.26%) stated that their stress/anxiety levels increased during the pandemic. The rapidly changing teaching technique, i.e., online education, has been the most fundamental factor in university students’ rising stress/anxiety levels. Uncertainties about the pandemic, health problems in and around them, fear of contagion, and loss of social life due to forced isolation were other identified factors [16]. Other studies conducted in China, Indonesia, and Greece have reported increased anxiety and depression among university students during the pandemic period [19,21,22,23,24,25,26].
The factors that were identified as having the greatest impact on the hopelessness level of Turkish medical students in this study, in descending order of % rank, were “lack of working environment”, “socioeconomic problems”, “family problems”, “health problems”, and “housing problems”. In the surveys conducted in all three periods, 50.4% of the students reported that they did not have any problems affecting the education process.
Throughout the study (March–July 2020), the only change seen in the ranking of the factors affecting the education process was that “family problems” rose to the second rank. Although there were some changes in the ratios of other factors during the selected periods, no changes were seen in the ranking. It can be conjectured that the main reason for this is that the majority of the students lived in their home/dormitory during the first survey (28 March 2020) and that their freedom was restricted as they were bound go to their family/parental home and start living with their families on the date of the second survey (28 April 2020) [27].
Previous studies have reported that Turkish medical students may be more prone to developing mental health problems than their peers in other countries. In another recent study conducted at a medical school in Türkiye, the mean score of the Beck Hopelessness Scale for students (n = 1015) in the preclinical period was 4.5 ± 0.1 (0–20), whereas a study published from China involving 2349 undergraduate medical students reported a total score of 5.07 ± 3.49 (0–20) on the Beck Hopelessness Scale [28,29,30].
Our study has more rigor than other, similar studies as it involved measurements taken during three separate periods, while others reported only one-time measurement. This provides a better understanding of the impact of the identified factors and their influence on Turkish medical students’ academic hopelessness. The change in Beck Hopelessness Scale total scores (0–20 points) according to the periods silent, proactive, and active was 6.58 ± 4.8 (n = 1419), 7.75 ± 5.57 (n = 1535), and 6.29 ± 4.9 (n = 626), respectively. In comparison with similar studies conducted before the pandemic, it can be inferred that the higher average of Beck Hopelessness Scale total scores found in our study is mainly linked to the effect of COVID-19 pandemic. Other similar studies conducted elsewhere during the pandemic period also support our current findings [16,19,20,21,31,32].
In studies conducted before the COVID-19 pandemic, it has been reported that the prevalence of depression and anxiety among first- and last-year students is higher than other grades. The most probable reason for this elevated depression and anxiety is the academic intensity of the first-year students and the employment anxiety of the last-year students [28,33]. To the best of our knowledge, this is the very first study reporting the appraisal of academic hopelessness levels in Turkish medical students with respect to different time periods of COVID-19 pandemic.
In our study, a significant difference in BHS total score and “Loss of motivation” was observed between Grade 1 (G1) and Grade 4 (G4) students during all three periods. The BHS total score of G4 students was found to be higher than that of G1 students. This may be attributed to the fact that G4 students are at the beginning of their clinical education training and may perceive a lack of basic medical skills due to disruptions in their education caused by the COVID-19 pandemic.
A previous study conducted in a Chinese medical school reported that having relatives or acquaintances infected with COVID-19 was identified as a risk factor for increasing students’ anxiety [21]. However, in our study, we found that the detection of COVID-19 in the family or relatives did not affect the level of hopelessness among medical students.
A larger sample study that examines the satisfaction of students from various countries regarding the educational process offered by their universities during the COVID-19 pandemic is warranted. Such a study would take into account the impact of academic, mental, and socio-demographic factors on student satisfaction. Recent reports have suggested that student satisfaction is higher in universities where new teaching techniques, such as recorded online lectures, have been adopted effectively and where institutional teaching support, such as adequate information being provided by the institution about exams or exam procedures during the crisis and effective communication policies, are in place. In this study, 86.7% of students reported awareness of the cancellation of face-to-face classes due to the COVID-19 outbreak and the implementation of a variety of online course teaching and learning formats in their universities. The most common forms of online education were real-time streaming video conferencing (59.4%), followed by asynchronous formats such as sending tutorials/presentations to students (15.2%), video recording (11.6%), and written communication using forums and chats (9.1%). The least adopted teaching format was audio recording (4.7%), possibly due to the widespread availability of online platforms and video conferencing systems (e.g., Moodle, Zoom, MS Teams, BigBlueButton) [15]. Based on these findings, it is recommended that educational institutions, particularly those dealing with practical subjects, be better prepared for extraordinary situations in the future.
In our study, a satisfaction scale was not utilized, as the change in the total scores of the Beck Hopelessness Scale (BHS) was used to evaluate the correlation between students’ hopelessness and the change in the number of active COVID-19 cases in the country, institutional training practices, and other contributing factors. A recent study has shown that the number of active COVID-19 cases has a negative impact on the mental health of medical school students [34]. In our study, the total score of BHS was 5.93 ± 4.58 at the end of the silent period, which was the preparation period for faculty members to adapt to unusual conditions. The total score of BHS was 6.45 ± 4.96 at the end of the proactive period, in which asynchronous training was started and preparations were made for synchronous training, and 5.49 ± 4.80 BHS total score was observed at the end of the active period, in which synchronous training and examinations were carried out. The increase in hopelessness level among medical students in the second period was possibly related to the increase in the active COVID-19 cases in the country [35], along with the inability to continue effective education practices and other discovered contributing factors (Figure 6). Figure 6 shows that the number of active cases increased in the proactive period (28 March: 7.224, 28 April: 72.852) but decreased significantly during the active period (7 July: 17.345). It can be surmised that the significant decrease in the level of hopelessness among participating students in the third active period was mainly related to the adopted effective institutional crisis-response strategies and the significant decrease in the number of active COVID-19 cases in the country.
5. Conclusions
In conclusion, the COVID-19 pandemic has led to increased feelings of hopelessness among medical students due to disruptions in education and concerns about their future medicine career. The study aimed to assess the impact of various factors such as socioeconomic status, family problems, health issues, and inadequate working environments on the level of hopelessness among medical students, as well as the impact of institutional crisis-response strategies. The study found that these factors were directly related to the level of hopelessness among students, and that effective institutional crisis-response strategies positively influenced the level of hopelessness. However, it is important to note that this study had limitations, such as the use of only one scale to measure hopelessness, the lack of a control group, and the solely online administration of the survey questionnaire. Future studies should consider using multiple scales to measure hopelessness and recruiting a control group to improve the rigor of the research. Another limitation of this study is that no qualitative follow-up, such as interviews, was conducted, meaning that the results are entirely based on self-reported survey responses.
In emergency situations, it is crucial for institutions to establish policies that ensure the continuity of education. In developing countries such as Türkiye, crisis management, particularly sustainable policies, cannot be implemented as systematically as in developed countries. In this study, we attempted to address an exceptional process during an extraordinary period.
Overall, the findings of this study highlight the need for preparedness and effective interventions to address the prevalence of hopelessness among medical students during crisis situations.
Supplementary Materials
The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/su15043049/s1, Table S1. Comparison by Gender; Table S2. Comparison by Gender.
Author Contributions
Conceived and designed the study and experiments: M.O.A., G.O., S.H., I.M.K. and Z.A. Performed the experiments: M.O.A., G.O., I.M.K. and Z.A. Analyzed the data: M.O.A., G.O., S.H., I.M.K. and Z.A. Contributed reagents/materials/analysis tools: M.O.A., G.O., S.H., I.M.K. and Z.A. Wrote the paper: M.O.A., G.O., S.H., I.M.K. and Z.A. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The local Institutional Review Board of Bursa Uludağ University, Bursa, Türkiye has approved this study.
Informed Consent Statement
Informed consent was obtained from all individuals included in this study.
Data Availability Statement
The data presented in this study are available on request from the corresponding author, Zuleyha Alper, upon reasonable request.
Acknowledgments
The authors are grateful to the Faculty of Medicine, Bursa Uludağ University, Bursa, Türkiye for providing the research facilities for this study.
Conflicts of Interest
The authors declare no conflict of interest.
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Figure 1.
Number of students participated in the study (classification by period and academic year).
Figure 1.
Number of students participated in the study (classification by period and academic year).
Figure 2.
Score of “loss of motivation” (classification by period and academic year).
Figure 3.
Score of “future expectation” (classification by period and academic year).
Figure 4.
Score of “feeling about the future” (classification by period and academic year).
Figure 5.
Total Score of BHS (classification by period and academic year).
Figure 6.
The Course of the Pandemic in Numbers in Türkiye—Change in the Number of Active Cases (28 March–7 July 2020) [35].
Figure 6.
The Course of the Pandemic in Numbers in Türkiye—Change in the Number of Active Cases (28 March–7 July 2020) [35].
Table 1.
Demographic information of the participants and other contributory factors impacting the education process.
Table 1.
Demographic information of the participants and other contributory factors impacting the education process.
| n | % | ||
|---|---|---|---|
| Periods | Silent | 1419 | 39.6% |
| Proactive | 1535 | 42.9% | |
| Active | 626 | 17.5% | |
| Grade | G1 | 868 | 24.2% |
| G2 | 790 | 22.1% | |
| G3 | 639 | 17.8% | |
| G4 | 641 | 17.9% | |
| G5 | 642 | 17.9% | |
| Gender | Women | 1922 | 53.7% |
| Man | 1658 | 46.3% | |
| Factors affecting education | No | 1789 | 50.0% |
| Yes | 1791 | 50.0% | |
| Financial problems | No | 3036 | 84.8% |
| Yes | 544 | 15.2% | |
| Housing problems | No | 3500 | 97.8% |
| Yes | 80 | 2.2% | |
| Family problems | No | 3099 | 86.6% |
| Yes | 481 | 13.4% | |
| Health problems | No | 3255 | 90.9% |
| Yes | 325 | 9.1% | |
| Lack of working environment | No | 2280 | 63.7% |
| Yes | 1300 | 36.3% | |
| Any problem affecting education process | No | 1805 | 50.4% |
| Yes | 1775 | 49.6% | |
| Others | None | 3537 | 98.8% |
| Yes | 43 | 1.2% | |
| COVID-19-positive status of the participant or his/her relatives | No | 3273 | 92.0% |
| Yes | 283 | 8.0% | |
Table 2.
Evaluation of BHS total and sub-factor scores according to periods.
| Total Number of Students n = 3580 | Periods | p-Value | ||
|---|---|---|---|---|
| Silent (n = 1419) | Proactive (n = 1535) | Active (n = 626) | ||
| Loss of motivation (8 questions) | 1.96 ± 1.92 a | 2.57 ± 2.33 b | 1.91 ± 1.93 a | <0.001 |
| Future expectations (5 questions) | 2.33 ± 1.52 a | 2.52 ± 1.61 b | 2.21 ± 1.5 a | <0.001 |
| Feelings about the future (5 questions) | 1.56 ± 1.63 a | 1.78 ± 1.81 b | 1.46 ± 1.68 a | <0.001 |
| BHS (20 questions) | 6.58 ± 4.8 a | 7.75 ± 5.57 b | 6.29 ± 4.9 a | <0.001 |
Descriptive statistics were given as mean ± standard deviation. The “a” and “b” superscripts show the results of pairwise comparisons between periods. The same superscript is used for periods with p > 0.05, and different superscripts are used for periods with p < 0.05.
Table 3.
Changes of BHS total and Sub-factor scores applied in three periods according to education period.
Table 3.
Changes of BHS total and Sub-factor scores applied in three periods according to education period.
| Grade | Periods | p | ||||||
| Silent | Proactive | Active | ||||||
| n | Mean ± SD | n | Mean ± SD | n | Mean ± SD | |||
| Loss of motivation (8 questions) | G1 | 342 | 1.86 ± 1.88 | 317 | 2.46 ± 2.22 | 209 | 1.75 ± 1.91 | <0.001 |
| G2 | 300 | 1.99 ± 1.92 | 363 | 2.6 ± 2.36 | 127 | 1.84 ± 1.78 | <0.001 | |
| G3 | 256 | 2 ± 1.87 | 248 | 2.69 ± 2.37 | 135 | 1.74 ± 1.82 | <0.001 | |
| G4 | 230 | 2.08 ± 2.05 | 317 | 2.66 ± 2.37 | 94 | 2.26 ± 2.14 | 0.009 | |
| G5 | 291 | 1.94 ± 1.9 | 290 | 2.43 ± 2.33 | 61 | 2.44 ± 2.09 | 0.014 | |
| p | 0.724 | 0.565 | 0.036 | |||||
| Future expectations (5 questions) | G1 | 342 | 2.13 ± 1.5 | 317 | 2.32 ± 1.57 | 209 | 2.06 ± 1.48 | 0.121 |
| G2 | 300 | 2.32 ± 1.49 | 363 | 2.52 ± 1.56 | 127 | 2.15 ± 1.42 | 0.038 | |
| G3 | 256 | 2.37 ± 1.47 | 248 | 2.58 ± 1.65 | 135 | 2.21 ± 1.51 | 0.068 | |
| G4 | 230 | 2.53 ± 1.56 | 317 | 2.69 ± 1.64 | 94 | 2.52 ± 1.53 | 0.407 | |
| G5 | 291 | 2.38 ± 1.57 | 290 | 2.51 ± 1.62 | 61 | 2.33 ± 1.58 | 0.528 | |
| p | 0.036 | 0.059 | 0.153 | |||||
| Feelings about the future (5 questions) | G1 | 342 | 1.31 ± 1.58 | 317 | 1.49 ± 1.7 | 209 | 1.27 ± 1.51 | 0.237 |
| G2 | 300 | 1.47 ± 1.6 | 363 | 1.76 ± 1.78 | 127 | 1.43 ± 1.7 | 0.045 | |
| G3 | 256 | 1.61 ± 1.61 | 248 | 1.87 ± 1.84 | 135 | 1.44 ± 1.72 | 0.048 | |
| G4 | 230 | 1.91 ± 1.77 | 317 | 2.03 ± 1.86 | 94 | 1.85 ± 1.84 | 0.641 | |
| G5 | 291 | 1.64 ± 1.58 | 290 | 1.76 ± 1.83 | 61 | 1.67 ± 1.82 | 0.727 | |
| p | <0.001 | 0.005 | 0.069 | |||||
| BHS (20 questions) | G1 | 342 | 5.86 ± 4.67 | 317 | 7.03 ± 5.31 | 209 | 5.71 ± 4.58 | 0.002 |
| G2 | 300 | 6.5 ± 4.75 | 363 | 7.78 ± 5.43 | 127 | 5.99 ± 4.7 | <0.001 | |
| G3 | 256 | 6.73 ± 4.64 | 248 | 8.1 ± 5.79 | 135 | 6.16 ± 4.88 | 0.001 | |
| G4 | 230 | 7.33 ± 5.12 | 317 | 8.32 ± 5.7 | 94 | 7.52 ± 5.33 | 0.094 | |
| G5 | 291 | 6.8 ± 4.8 | 290 | 7.58 ± 5.61 | 61 | 7.31 ± 5.38 | 0.198 | |
| p | 0.006 | 0.041 | 0.016 | |||||
Table 4.
Evaluation of BHS Scores of the factors affecting the education process in all the three periods.
Table 4.
Evaluation of BHS Scores of the factors affecting the education process in all the three periods.
| Periods | p | |||||||
|---|---|---|---|---|---|---|---|---|
| Silent | Proactive | Active | ||||||
| n | Mean ± SD | n | Mean ± SD | n | Mean ± SD | |||
| Financial problems | Loss of motivation | 228 | 2.46 ± 2.02 a | 208 | 3.31 ± 2.68 b | 108 | 2.3 ± 2.2 a | <0.001 |
| Future expectations | 228 | 2.77 ± 1.42 a | 208 | 3.02 ± 1.63 ab | 108 | 2.5 ± 1.54 ac | 0.014 | |
| Feelings about the future | 228 | 1.79 ± 1.66 a | 208 | 2.33 ± 1.95 b | 108 | 1.64 ± 1.87 a | 0.001 | |
| BHS total score | 228 | 7.89 ± 4.79 a | 208 | 9.7 ± 6.11 b | 108 | 7.28 ± 5.31 a | <0.001 | |
| Housing problems | Loss of motivation | 22 | 3.27 ± 2.37 | 44 | 4.11 ± 2.81 | 14 | 2.21 ± 2.04 | 0.053 |
| Future expectations | 22 | 2.59 ± 1.56 | 44 | 3.2 ± 1.8 | 14 | 2.79 ± 1.12 | 0.329 | |
| Feelings about the future | 22 | 1.45 ± 1.71 ac | 44 | 2.7 ± 2.11 bc | 14 | 1.43 ± 1.74 c | 0.020 | |
| BHS total score | 22 | 8.05 ± 5.51 | 44 | 11.25 ± 6.64 | 14 | 7.43 ± 4.6 | 0.044 * | |
| Family problems | Loss of motivation | 145 | 2.55 ± 2.11 a | 208 | 3.82 ± 2.75 b | 128 | 2.41 ± 2.13 a | <0.001 |
| Future expectations | 145 | 2.91 ± 1.33 | 208 | 3.26 ± 1.57 | 128 | 2.94 ± 1.38 | 0.042 * | |
| Feelings about the future | 145 | 2 ± 1.76 a | 208 | 2.56 ± 1.98 b | 128 | 1.95 ± 1.8 a | 0.004 | |
| BHS total score | 145 | 8.38 ± 4.83 a | 208 | 10.81 ± 6.12 b | 128 | 8.17 ± 5.04 a | <0.001 | |
| Health problems | Loss of motivation | 115 | 2.61 ± 2.12 a | 143 | 3.59 ± 2.71 b | 67 | 2.03 ± 1.8 a | <0.001 |
| Future expectations | 115 | 2.9 ± 1.47 | 143 | 3.13 ± 1.62 | 67 | 2.63 ± 1.39 | 0.075 | |
| Feelings about the future | 115 | 1.81 ± 1.65 a | 143 | 2.49 ± 1.88 b | 67 | 1.79 ± 1.8 a | 0.003 | |
| BHS total score | 115 | 8.17 ± 4.8 a | 143 | 10.3 ± 6.19 b | 67 | 7.21 ± 4.59 a | <0.001 | |
| Lack of working environment | Loss of motivation | 416 | 2.32 ± 2.08 a | 654 | 3.09 ± 2.52 b | 230 | 2.15 ± 2.01 a | <0.001 |
| Future expectations | 416 | 2.67 ± 1.42 a | 654 | 2.87 ± 1.62 ab | 230 | 2.51 ± 1.51 ac | 0.006 | |
| Feelings about the future | 416 | 1.89 ± 1.71 a | 654 | 2.12 ± 1.88 ab | 230 | 1.75 ± 1.75 ac | 0.015 | |
| BHS total score | 416 | 7.77 ± 4.97 a | 654 | 9.1 ± 5.8 b | 230 | 7.26 ± 5 a | <0.001 | |
| Have no problems | Loss of motivation | 792 | 1.7 ± 1.77 ac | 670 | 1.97 ± 1.94 bc | 313 | 1.68 ± 1.86 c | 0.010 |
| Future expectations | 792 | 2.06 ± 1.53 | 670 | 2.11 ± 1.52 | 313 | 1.87 ± 1.43 | 0.055 | |
| Feelings about the future | 792 | 1.41 ± 1.6 | 670 | 1.4 ± 1.64 | 313 | 1.17 ± 1.52 | 0.059 | |
| BHS total score | 792 | 5.82 ± 4.63 a | 670 | 6.22 ± 4.93 ab | 313 | 5.3 ± 4.65 ac | 0.016 | |
| Other | Loss of motivation | 9 | 1.78 ± 1.48 | 31 | 2.32 ± 1.9 | - | - | 0.435 |
| Future expectations | 9 | 1.78 ± 1.64 | 31 | 2.16 ± 1.51 | - | - | 0.514 | |
| Feelings about the future | 9 | 1.78 ± 1.48 | 31 | 1.58 ± 1.73 | - | - | 0.758 | |
| BHS total score | 9 | 5.78 ± 4.12 | 31 | 6.97 ± 4.8 | - | - | 0.504 | |
| General problems | Loss of motivation | 628 | 2.32 ± 2.04 a | 843 | 3.06 ± 2.5 b | 320 | 2.14 ± 1.97 a | <0.001 |
| Future expectations | 628 | 2.68 ± 1.43 a | 843 | 2.86 ± 1.6 ab | 320 | 2.54 ± 1.47 ac | 0.003 | |
| Feelings about the future | 628 | 1.77 ± 1.65 a | 843 | 2.08 ± 1.88 b | 320 | 1.76 ± 1.77 a | 0.001 | |
| BHS total score | 628 | 7.62 ± 4.81 a | 843 | 9 ± 5.75 b | 320 | 7.27 ± 4.91 a | <0.001 | |
* Although there was a statistically significant difference as a result of the general comparison, but there was no significant difference between the groups as a result of pairwise comparisons. The “a”, “b” and “c” superscripts show the results of pairwise comparisons between periods. The same superscript is used for periods with p > 0.05, and different superscripts are used for periods with p < 0.05.
Table 5.
Changes in BHS Total and Sub-factor scores according to periods as a result of the exclusion of students with “Lack of Working Environment” and “Family Problems”.
Table 5.
Changes in BHS Total and Sub-factor scores according to periods as a result of the exclusion of students with “Lack of Working Environment” and “Family Problems”.
| Periods | p | |||
|---|---|---|---|---|
| Silent (n = 932) | Proactive (n = 826) | Active (n = 350) | ||
| Loss of motivation (8 questions) | 1.74 ± 1.78 a | 2.04 ± 1.97 b | 1.75 ± 1.91 a | 0.002 |
| Future expectations (5 questions) | 2.14 ± 1.53 a | 2.20 ± 1.53 a | 1.91 ± 1.45 b | 0.009 |
| Feelings about the future (5 questions) | 1.40 ± 1.57 | 1.44 ± 1.66 | 1.22 ± 1.60 | 0.094 |
| BHS (20 questions) | 5.93 ± 4.58 a | 6.45 ± 4.96 ab | 5.49 ± 4.80 ac | 0.004 |
Descriptive statistics were given as mean ± standard deviation. The “a”, “b” and “c” superscripts show the results of pairwise comparisons between periods. The same superscript is used for periods with p > 0.05, and different superscripts are used for periods with p < 0.05.
Table 6.
Effect of COVID-19 detection in him/herself and his/her surroundings on BHS total score.
| Total BHS Score | Periods | p | |||
|---|---|---|---|---|---|
| Silent | Proactive | Active | |||
| Do you or your family have a case of COVID-19? | No | 6.60 ± 4.80 a | 7.76 ± 5.52 b | 6.39 ± 4.92 a | <0.001 |
| Yes | 6.15 ± 4.92 a | 7.55 ± 5.87 ab | 5.79 ± 4.86 ac | 0.037 | |
The “a”, “b” and “c” superscripts show the results of pairwise comparisons between periods. The same superscript is used for periods with p > 0.05, and different superscripts are used for periods with p < 0.05.
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Aydin, M.O.; Ozkaya, G.; Kafa, I.M.; Haque, S.; Alper, Z. Hopelessness among Medical Students Caused Due to COVID-19 Pandemic Linked Educational Hiatus: A Case Study of Bursa Uludag University, Türkiye. Sustainability 2023, 15, 3049. https://doi.org/10.3390/su15043049
AMA Style
Aydin MO, Ozkaya G, Kafa IM, Haque S, Alper Z. Hopelessness among Medical Students Caused Due to COVID-19 Pandemic Linked Educational Hiatus: A Case Study of Bursa Uludag University, Türkiye. Sustainability. 2023; 15(4):3049. https://doi.org/10.3390/su15043049
Chicago/Turabian StyleAydin, Mevlut Okan, Guven Ozkaya, Ilker Mustafa Kafa, Shafiul Haque, and Zuleyha Alper. 2023. "Hopelessness among Medical Students Caused Due to COVID-19 Pandemic Linked Educational Hiatus: A Case Study of Bursa Uludag University, Türkiye" Sustainability 15, no. 4: 3049. https://doi.org/10.3390/su15043049
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