The emotions, coping strategies and learning behaviours of medical students during quarantine period of COVID-19

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Submitted: 30 April 2024
Accepted: 25 September 2024
Published online: 1 April, TAPS 2025, 10(2), 86-90
https://doi.org/10.29060/TAPS.2025-10-2/SC3551

Ozlem Tanriover1, Sukran Peker2, Seyhan Hidiroglu2, Dilek Kitapcioglu3 & M. Ali Gülpınar1

1Department of Medical Education, School of Medicine, Marmara University, Türkiye; 2Department of Public Health, School of Medicine, Marmara University, Türkiye; 3Department of Medical Education, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Türkiye

Abstract

Introduction: This study aimed to identify the emotions experienced by medical students during the quarantine period, explore their coping strategies, and determine whether the pandemic affected their learning behaviours.

Methods: In this descriptive study, data were collected through an online questionnaire. The study included quarantined medical students enrolled in a distance education program at a medical school during the pandemic. The Positive and Negative Affect Scale was used to assess the emotional spectrum of the participants.

Results: The majority of medical students in the sample experienced predominantly negative emotions. Students with higher negative affect scores struggled with stress management and were less able to employ emotional regulation strategies, which adversely affected their learning behaviours.

Conclusion: Emotions should be explicitly addressed in medical education, and students should be supported in managing their emotions as part of their professional development and well-being.

Keywords:           Coping, Emotions, Emotion Regulation, Medical Student, Pandemic, Stress

I. INTRODUCTION

Medical education has long been a significant source of stress for students. The COVID-19 pandemic introduced additional challenges with social distancing, home confinement, and online learning, further intensifying this burden (Fegert et al., 2020). In Turkey, the Council of Higher Education suspended face-to-face education on March 26, 2020, shifting all theoretical and some practical medical courses online. This move removed students from campuses and hospital settings to protect public health. As a result, medical students from all years, including those close to graduation, were quarantined and separated from their academic routines.

Quarantine, a measure to prevent disease spread, often leads to frustration, boredom, and heightened distress (Brooks et al., 2020). Medical education is already emotionally taxing, and the pandemic amplified these challenges. While many studies have explored the emotions of healthcare workers and students on the front lines, little is known about how medical students in Turkey, confined at home, experienced and coped with this period. This study aims to explore their emotional experiences, coping mechanisms, and changes in learning behaviours during quarantine.

II. METHODS

This descriptive study utilised an online questionnaire sent via Microsoft Forms to medical students from a university in Istanbul. Participants included both preclinical and clinical students, all engaged in distance learning due to the pandemic. The survey was distributed in June 2020, with participation being voluntary and anonymous. The study ran from mid-June to the end of July 2020.

A. Ethical Approval

The study was approved by the School of Medicine Ethical Committee (No. 09.2020.657). Consent was obtained from all participants before data collection.

B. Data Collection

The questionnaire gathered sociodemographic data and inquired about online education experiences. The Positive and Negative Affect Scale (PANAS), developed by Watson et al. (1988) and adapted to Turkish by Gençöz (2000), was used to assess emotions. The PANAS contains 20 adjectives rated on a five-point Likert scale, with scores ranging from 10 to 50 for both positive and negative emotions. High positive scores reflect engagement and energy, while high negative scores indicate distress.

C. Statistics

Statistical analysis was conducted using SPSS 20.0. Normality was tested with Kolmogorov-Smirnov and Shapiro-Wilk tests. Descriptive statistics were presented as medians (IQR) for non-normal data and frequencies for categorical data. The Mann-Whitney U test was used for two-group comparisons, and the Kruskal-Wallis test for comparisons across more than two groups. A p-value < 0.05 was considered statistically significant.

III. RESULTS

A total of 145 students participated in the survey, with a slight female majority (57%, n=83). The participants’ ages ranged from 20 to 27 years (mean=21.4, SD=1.99), and most (93%, n=135) lived at home with their families. Students attended an average of 4-6 hours of online lectures per day during quarantine. Emotions such as “interested,” “alert,” and “enthusiastic” had low scores, while 63.4% reported feeling distressed, followed by 40.7% upset and 39.3% irritable.

The PANAS total score comparison showed that students aged 22-25 scored significantly higher than those aged 18-21 (51.7 vs 48.1, p=0.028). Similarly, positive affect (PA) scores were higher in older students (p<0.001). Students living alone had higher total PANAS scores (59 vs 49, p=0.008) and PA scores (31.7 vs 23.6, p<0.001) than those living with their families.

A. Coping Strategies

Most students (65.5%) coped with stress using distraction activities like watching TV, while 8.3% sought emotional support. A minority engaged in substance use or denial (4.9%), and 8.3% reported being unable to cope. Those who made an effort to cope had higher PA scores (24.6 vs 21.2, p=0.036) and lower negative affect (NA) scores (25.3 vs 29.5, p=0.01).

B. Changes in Learning Behaviour

About 74.5% of students reported changes in their study methods during the pandemic, though no significant differences in PANAS scores were observed. When asked about adapting to online learning, 33.7% of students reported difficulty adjusting, while 17.3% used self-motivation, and 11.5% created study programs with peers.

C. Emotion Regulation

Cognitive reappraisal was the most common strategy used by 65.5% of students to manage emotions, while 8.3% used expressive suppression. Nearly 25% reported no effective emotion regulation strategy, and 1.4% felt they didn’t need one. Those who used emotion regulation strategies had significantly lower NA scores (p=0.017).

Variables

PA TOTAL

NA TOTAL

Median (IQR)

p

Median (IQR)

p

Gender

Women

23 (7)

0.69

24(13)

0.39

Men

24 (12.25)

24.5(12.25)

Age

18-21 y

21(6.5)

<0.01

25(13)

0.28

22-25 y

26(10.75)

24(9.75)

Class

Basic Sciences

21(7)

<0.001

25(12)

>0.05

Clinical Sciences

28.5(10.5)

24(13.25)

Living Arrangement

At home

23(8)

>0.05

25(11.75)

>0.05

Dormitory

23(5.5)

20(8.5)

Who do you live with? 

With family

23(8.25)

<0.001

24(12.5)

0.639

With friends

23(7)

24(8)

Alone

33(10)

25(12)

Volunteered During Pandemic

Yes

26.5(9.25)

>0.05

23.5(21)

>0.05

No

23(8.5)

24(11.5)

Distance Education Experience

Yes

23(8)

>0.05

27(12)

>0.05

No

24(9.25)

24(12.25)

Infrastructure Suitability

Yes

23(8.75)

>0.05

24(12)

>0.05

No

22(10.5)

28 (13)

Training Management System Usage

Yes

23(9)

p>0.05

24(12)

p>0.05

No

25(7.55)

27(15.75)

Table 1. The comparison of the sociodemographic data of the participants with the PANAS median scores

IV. DISCUSSION

This study is the first to explore the emotional experiences of medical students in Turkey during the COVID-19 quarantine period, offering critical insights into how students coped with stress and adapted to the rapid shift to online education. Our findings suggest that medical students predominantly experienced negative affect, with emotions such as distress, irritability, and nervousness being highly prevalent. This aligns with global research during the pandemic, which reported heightened levels of anxiety, stress, and emotional dysregulation among students (Kostic et al., 2021). 

One of the most striking findings of our study is the significant role of positive affect (PA) in students’ ability to cope with stress. Students with higher PA scores were more likely to report engaging in adaptive coping strategies, such as cognitive reappraisal and self-motivation. Cognitive reappraisal, in particular, was the most frequently used emotion regulation strategy among the students, highlighting the importance of reframing challenging situations in a more positive light. This ability to change one’s perspective is a valuable skill, especially in stressful academic environments like medical school. It allows students to manage their emotional responses more effectively, thereby reducing the likelihood of burnout and enhancing their capacity for professional growth. 

In contrast, students who reported higher levels of negative affect (NA) were more likely to struggle with stress management and adaptation to online education. This is consistent with existing research that links negative emotional states, such as anxiety and distress, with poorer academic performance and lower motivation (Tanriover et al., 2023). Additionally, students with high NA scores were more likely to rely on maladaptive coping strategies or, in some cases, to exhibit no effort to cope with stress at all. This highlights a key area for intervention, as students who are unable to regulate their emotions are at greater risk of developing mental health issues, which can impede their academic and professional development. 

Our findings also revealed interesting differences based on living arrangements. Students living alone had higher PA scores compared to those living with their families, possibly due to the greater autonomy and control they experienced over their environments. In contrast, students living with their families reported more stress, potentially due to concerns about the health and safety of their family members or financial pressures exacerbated by the pandemic. These results suggest that the home environment plays a crucial role in shaping students’ emotional well-being during periods of crisis. Medical schools should consider these contextual factors when designing support systems for students, particularly in situations where they may be confined to their homes for extended periods, as was the case during the pandemic.

The shift to online education posed additional challenges for medical students, many of whom struggled to adapt their study methods to the new format. The vast majority (74.5%) of students in our study reported that their study methods had changed during the pandemic, but there was no significant difference in PANAS scores based on these changes. However, it is worth noting that a sizable proportion of students (33.7%) stated that they could not adapt to the new learning environment. This highlights the need for more structured guidance and support from educational institutions to help students navigate the transition to online learning. Studies have shown that students benefit from peer collaboration, instructor support, and a clear organisational structure when adapting to new learning methods (Dhawan, 2020). In this regard, medical schools should invest in developing comprehensive online education strategies that not only address the technical aspects of remote learning but also support students’ emotional and motivational needs.

The findings of this study underscore the importance of emotional regulation in medical education. Emotional awareness and the ability to regulate one’s emotions are essential skills for medical students, not only for their academic success but also for their long-term professional well-being. The high prevalence of negative affect among the students in our study suggests that more attention needs to be paid to the emotional aspects of medical training. Medical education programs should incorporate training on emotional regulation and coping strategies into their curricula. Such training can help students manage the emotional challenges they face, both in their academic pursuits and in their future careers as healthcare professionals.  

Moreover, peer support programs, which encourage students to share their experiences and coping strategies with one another, could foster a sense of community and reduce feelings of isolation. Our study found that students who engaged in collaborative learning methods, such as studying with peers, were better able to adapt to the new online education environment. This suggests that creating opportunities for social connection and peer support is critical, especially during times of crisis when traditional forms of social interaction may be limited.

V. CONCLUSION

These findings highlight the critical role of emotional awareness and regulation in medical students’ well-being, especially in times of crisis. Addressing emotions explicitly in medical education curricula and providing support for students to manage stress and regulate their emotions should be integral to fostering their professional growth and resilience. 

Notes on Contributors

OT designed the study; interpretated the data, wrote the draft of the manuscript and approved the final version to be published.

SP collected and analysed the data, interpretated the data and approved the final version to be published.

SH collected and analysed the data, interpretated the data and approved the final version to be published.

DK made critical revisions to the paper for important intellectual content and approved the final version to be published.

M.A.G contributed to the conception, made critical revisions to the paper for important intellectual content and approved the final version to be published. 

Ethical Approval

The study was approved by the Marmara University School of Medicine Ethical Committee (No. 09.2020.657). Consent was obtained from all participants before data collection. 

Data Availability

Based on the ethics approval, data will not be shared on a repository. The anonymised dataset can be obtained from the corresponding author with request.  A preprint of our manuscript, which is not peer-reviewed, is available at https://www.researchsquare.com/article/rs-2849167/v1 

Acknowledgement

We are grateful to all the medical students who participated in this study.

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors. 

Declaration of Interest

Possible conflicts of interest, sources of financial support, corporate involvement, patent holdings, consultant, institutional and other relationships that might lead to bias or a conflict of interest do not exist. 

References

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet, 395(10227), 912-920. https://doi.org/10.1016/S0140-6736(20)30460-8  

Dhawan, S. (2020). Online learning: A panacea in the time of COVID-19 crisis. Journal of Educational Technology Systems, 49(1), 5-22. https://doi.org/10.1177/0047239520934018  

Fegert, J. M., Vitiello, B., Plener, P. L., & Clemens, V. (2020). Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: A narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child and Adolescent Psychiatry and Mental Health, 14(1), 20. https://doi.org/10.1186/s13034-020-00329-3

Kostic, J., Zikic, O., Dordevic, V., & Krivokapic, Z. (2021). Perceived stress among university students in south-east Serbia during the COVID-19 outbreak. Annals of General Psychiatry, 20(1), 25. https://doi.org/10.1186/s12991-021-00346-2

Tanriover, O., Peker, S., Hidiroglu, S., Kitapcioglu, D., Inanici, S. Y., Karamustafalioglu, N., & Gulpinar, M. A. (2023). The emotions experienced by family medicine residents and interns during their clinical trainings: A qualitative study. Primary Health Care Research & Development, 24(e25), 1-8. https://doi.org/10.1017/S1463423623000051

*Prof. Ozlem Tanriover
Marmara University School of Medicine
Department of Medical Education
Marmara Universitesi Tıp Fakültesi 
Başıbüyük Mah Maltepe Başıbüyük Yolu Sok
No:9/2 Maltepe – İstanbul/Türkiye
+90 216 777 55 39
Email: drozlemtan56@gmail.com

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