How Did the COVID-19 Pandemic Impact Medical Students From Low- vs Higher-Socioeconomic Status Backgrounds? A Multicenter US Survey Study

Purpose: Medical schools’ efforts to prioritize student diversity often focus on visible identities. While many schools have focused on increasing student representation from diverse racial and ethnic backgrounds, efforts to address invisible aspects of diversity, such as socioeconomic status (SES), have been more limited. However, invisible aspects of diversity, such as SES, also need to be addressed. 1,2 Low-SES medical students experience persistent barriers in getting to and completing medical school, which may have been exacerbated by the COVID-19 pandemic. The purpose of the study was to evaluate how the COVID-19 pandemic impacted medical students from low SES as compared with higher-SES backgrounds. Method: Participants from 14 U.S. medical schools were surveyed in March–May 2021 using an 88-item questionnaire containing standardized survey tools, multiple-choice and open-ended questions. Low SES was defined if students met one of the following 3 measures: the Association of American Medical Colleges Employment-Occupation SES-disadvantaged indicator, household childhood income in bottom 2 quintiles, or self-classification into a lower SES category. 3–5 Low-SES students’ responses were compared with higher-SES peers. Standard descriptive statistics and multivariable generalized estimating equation models adjusting for confounders were used. Analysis was done in R 3.6.1. Results: Of 6,836 eligible students, 1,555 (22.7%) responded. Low-SES students compared with their higher-SES peers were more likely to report difficulty accessing adequate resources for remote learning [odds ratio (OR) 1.44 (1.14–1.81), P = .014], difficulty affording basic needs during the pandemic [OR 7.64 (3.85–15.16), P < .001], need to take out more loans to support themselves or families [OR 2.68 (2.04–3.53), P < .001], need to seek employment to support themselves or families [OR 2.40 (1.56–3.70), P < .001], and loss of employment by one or more of their parents or guardians [OR 2.45 (1.58–3.81), P < .001]. Compared with their higher-SES peers, low-SES students were 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 < .001]. Discussion: In this multi-school U.S. survey study, we demonstrated that low-SES medical students experienced more challenges related to the COVID-19 pandemic compared with their higher-SES peers. To close this gap and create a more equitable learning environment that supports a socioeconomically diverse student body, it is critical to examine the unique challenges low-SES students face and reassess how schools can better support low-SES students, particularly in the setting of the ongoing COVID-19 pandemic. Significance: This is the first multisite study to describe the impact of students’ SES on their experiences at U.S. medical schools and the impact of the COVID-19 pandemic on their experiences. The results of this study can be used to guide interventions to support low-SES medical students and to promote socioeconomic diversity in medicine. More research is also needed on this topic. Acknowledgments: The authors wish to thank the 14 medical schools for their participation in their study, Mengqi Zhu, MS, for her guidance on statistical analysis, and the Medical Student Wellbeing Research Consortium members.