Since January 2020 Elsevier has created a COVID-19 resource centre with

free information in English and Mandarin on the novel coronavirus COVID-

19. The COVID-19 resource centre is hosted on Elsevier Connect, the
company's public news and information website.

Elsevier hereby grants permission to make all its COVID-19-related

research that is available on the COVID-19 resource centre - including this
research content - immediately available in PubMed Central and other
publicly funded repositories, such as the WHO COVID database with rights
for unrestricted research re-use and analyses in any form or by any means
with acknowledgement of the original source. These permissions are
granted for free by Elsevier for as long as the COVID-19 resource centre
remains active.
 j o u r n a l o f s u r g i c a l r e s e a r c h 2 5 8 ( 2 0 2 1 ) 2 1 3 e2 1 5

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.JournalofSurgicalResearch.com

Perspectives During the COVID-19 Pandemic

The Impact of COVID-19 Pandemic on Medical

School Admissions: Challenges and Solutions

Background student attainment, MCAT performance, and medical school

acceptance. With this reduced ability to partake in early lab-
The coronavirus disease 2019 (COVID-19) pandemic has oratory research, students may face a disadvantage on mul-
brought hardship. With the pandemic, there is a need for more tiple levels.
health care professionals; yet, premedical students face Many shadowing and volunteering experiences were
additional hurdles in applying to medical school. The process canceled for premedical students because of the pandemic.
of applying to US medical schools before the COVID-19 Volunteering and shadowing are crucial for premedical stu-
pandemic was competitive, with an average acceptance rate dents to determine their fit and desire for a career in medi-
of 6.7% in 2019.1 Now with many unforeseen challenges, cine and demonstrate commitment as a prospective doctor.
premedical students applying during 2020, 2021, and subse- With social distancing requirements and limited personal
quent application cycles should be prepared for the changes protection equipment, premedical students are largely
that the pandemic has necessitated. excluded from in-person medical experiences. The American
The COVID-19 pandemic has resulted in a lack of in-person Medical Association has said that it is unknown how long
science courses and laboratories, reduced ability for face-to- these limits will last.7 This reduced ability for premedical
face experiences in shadowing or volunteering, sudden students to experience the day-to-day interactions of a
changes to the Medical College Admission Test (MCAT), and physician may lead to applicants with unrealistic expecta-
changes to deadlines. These changes may impact the next tions and contribute to the already high rate of physician
generation of medical students, who will become the next burnout.8
generation of residents, surgeons, and surgeon educators.
This perspective will highlight the challenges of applying to
medical school during the COVID-19 pandemic and propose MCAT challenges
evidence-based recommendations to ease the additional
burden on the medical school admissions process. The MCAT is one of the most important knowledge metrics
used to evaluate the ability to succeed as a medical student
and doctor. Most students prepare for the MCAT over
In-person challenges several months, with peak testing periods during the
spring. The spread of COVID-19 brought about the closure
The comprehension and performance in core science courses, of all testing centers across the country during this peak
such as chemistry, biology, and biochemistry, can be greatly time.9,10
impaired by changes to the teaching style. With social In response to COVID-19, social distancing requirements,
distancing requirements set by the Centers for Disease Con- and the cancelations of examinations, the Association of
trol and Prevention, most colleges and universities have American Medical Colleges (AAMC) decided to reformat the
moved classes to an online lecture format.2,3 Bawa found that examination by shortening the MCAT from 7.5 h to 5.75 h for
perceptions of students and teachers about online courses are the rest of this testing season.10 The shortened MCAT will
dramatically different, resulting in confusion and dissatis- still cover all four sections of the longer version and will test
faction for students.4 This confusion could be detrimental for the same knowledge and skills at the same level of difficulty
premedical students who need the knowledge from core as the full-length examination according to the AAMC.10 In
courses for the MCAT and their educational foundation. In addition, the scoring will remain the same as the full-length
addition, Kayser determined that a service-learning pedagogy examination. The AAMC also decided to expedite score re-
using experiential-based learning is important for premedical leases.10 The MCAT scores were previously released in 4 wk,
students to stimulate compassion, cultural competence, and but this period was changed to 2 wk to allow students a
community-responsive skills.5 Vincent-Ruz et al.6 found that competitive advantage in applying early in the application
early experiences in undergraduate research correlated to cycle.
214 j o u r n a l o f s u r g i c a l r e s e a r c h 2 5 8 ( 2 0 2 1 ) 2 1 3 e2 1 5

clerkship director local medical school is using remote simu-

Deadline challenges lation with avatars to carry out in-person techniques (G.
Miller, personal communication, August 22, 2020). The tech-
With the cancelation of many MCAT examinations and the nical skill is not gained, but decision-making improves.
additional stress caused by the COVID-19 pandemic, the Furthermore, some trauma centers are using virtual reality
AAMC recognized that premedical students applying during medical simulations to train medical students and early-
the 2021 cycle would need additional time to fill out their career doctors.15 Virtual learning platforms have been help-
medical school application.11 Consequently, the AAMC has ful in providing online courses and a method to practice
delayed the transmission of applicant data to medical schools technical skills during COVID-19.16 Such virtual learning, used
by 2 wk to give students additional time to complete their for surgical residents, can be useful for all levels of medical
application.12 This means that applicants will have more time training to prevent burnout and allow time to focus on tech-
to enter their coursework, clinical and volunteering experi- nical skills. Premedical students can be included in these
ences, and personal statement before the system begins types of experiences to provide further exposure to the field of
transmitting applications to medical schools. Nevertheless, medicine. During a peak in COVID-19 cases, a general surgery
the application for 2021 opened on May 4 and could be sub- training program used remote technology to do bedside
mitted starting May 28, as previously planned.12 rounds.17 Another center used telemedicine meetings for
The AAMC has left it up to individual medical schools to subjects such as trauma surgery and patient safety, which
determine whether to push back the deadlines for the primary was found to increase students’ interest.18 Premedical stu-
application and have encouraged students to use the Medical dents could also be included in these telehealth meetings to
School Admission Requirements online database to monitor increase medical exposure. These methods to avoid pandemic
individual school policies and requirements.12 One of the exposure could allow premedical student volunteer experi-
biggest challenges for 2020 applicants is attending interviews, ence. Surgeons can also offer support by speaking with pre-
which are difficult to get to with the stay-at-home orders and medical students about their experience in surgery to
travel restrictions. Many medical schools have adopted a vir- compensate for the lack of shadowing abilities. This would
tual interview format to accommodate applicants who are ensure that students are provided with a realistic perspective
unable to travel and to protect the health and safety of the and are inspired to pursue surgical specialties. Surgeons can
interviewers and interviewees. The question remains, Will further provide premedical students with expedited letters of
these changes persist after the pandemic has subsided? recommendation and additional guidance during the changes
caused by COVID-19. This would help ease the burden of
deadline changes and give premedical students the support
Overcoming the challenges and experience needed to get accepted into medical school at
this time.
One of the marvels of the medical field is its ability to over- The COVID-19 pandemic has presented an opportunity
come challenges (diseases) and push boundaries (cures) to refine the medical school application process. Premedi-
beyond what has been done before. This COVID-19 pandemic cal students must be kept informed of the alterations and
will be no different. Medicine will prevail, and so will the challenges occurring during this rapidly changing
medical school admissions process. Overcoming the addi- situation.
tional challenges caused by the COVID-19 pandemic is
achievable. For instance, Carpenter designed an online un-
dergraduate chemistry course where information is conveyed
using digital pen and paper in combined audiovisual lectures Conclusion
that are fully controlled by the students to adjust information
flow and repetition.13 Course designs such as this could be The COVID-19 pandemic has resulted in global hardships for
used in medical school and residency to ensure that students everyone; yet in the premedical community, there is still an
are not affected by the in-person restrictions. Furthermore, unwavering desire to enter the field of medicine. In a time
this could be used in continuing medical education courses for when there is a desperate need for health care professionals,
current physicians. this is great news. Nevertheless, the pandemic has pre-
Beyond this, many premedical students have determined sented additional challenges for premedical students
alternative ways to give back and support their communities applying to medical school, which are currently being
despite the in-person restrictions. The American Medical As- fought.
sociation has suggested volunteering with phone triage to
assist health systems and public health entities in reducing
the number of patients in the emergency room.14 Surgeons
and surgeon educators can help premedical students remain Acknowledgment
involved by offering virtual volunteer positions, such as
remote research opportunities in assembling literature re- Funding: none.
views or conducting statistical analyses. These are tasks that Authors’ contributions: B.D. and A.E. contributed to study
undergraduate students would thrive at and would help sur- design; conception; data collection, interpretation, and anal-
gical research teams. Volunteering and contributing while ysis; and article. All authors critically revised the article and
social distancing will require imagination and diligence. The read and approved the final article.
 j o u r n a l o f s u r g i c a l r e s e a r c h 2 5 8 ( 2 0 2 1 ) 2 1 3 e2 1 5 215

13. Carpenter S. 3-in-1: design and gamified delivery of an online

Disclosure pre-med organic chemistry/biochemistry course. In:
Interdisciplinary STEM Teaching & Learning Conference; 2019:47.
The authors reported no proprietary or commercial interest in Available at: https://digitalcommons.georgiasouthern.edu/
any product mentioned or concept discussed in this article stem/2019/2019/47. Accessed June 30, 2020.
14. Murphy B. 5 ways medical students can assist during the
COVID-19 pandemic. American Medical Association.
references Available at: https://www.ama-assn.org/delivering-care/
public-health/5-ways-medical-students-can-assist-during-
covid-19-pandemic. Accessed July 30, 2020.
15. Couperus K, Young S, Walsh R, et al. Immersive virtual reality
1. Moody J. 10 Med Schools With the Lowest Acceptance Rates; 2020. medical simulation: autonomous trauma training simulator.
U.S. News & World Report; 2020. Available at: https://www. Cureus. 2020;12:e8062.
usnews.com/education/best-graduate-schools/the-short-list- 16. Ehrlich H, McKenney M, Elkbuli A. We asked the experts:
grad-school/articles/medical-schools-with-the-lowest- virtual learning in surgical education during the COVID-19
acceptance-rates. Accessed June 1, 2020. pandemic-shaping the future of surgical education and
2. Social Distancing, Quarantine, and Isolation. Centers for training. World J Surg. 2020;44:2053e2055.
Disease Control and Prevention; 2020. Centers for Disease 17. Meneses E, McKenney M, Elkbuli A. Reforming our general
Control and Prevention; 2020. Available at: www.cdc.gov/ surgery residency program at an urban level 1 trauma center
coronavirus/2019-ncov/prevent-getting-sick/social- during the COVID-19 pandemic. Toward maintaining resident
distancing.html. Accessed June 2, 2020. safety wellbeing. Am J Surg. 2020;220:847e849.
3. Hess A. How Coronavirus Dramatically Changed College for Over 18. Pereira BM, Calderan TR, Silva MT, Silva AC, Marttos Jr AC,
14 Million Students; 2020. CNBC; 2020. Available at: https:// Fraga GP. Initial experience at a university teaching hospital
www.cnbc.com/2020/03/26/how-coronavirus-changed- from using telemedicine to promote education through video
college-for-over-14-million-students.html. Accessed June 2, conferencing. Sao Paulo Med J. 2012;130:32e36.
2020.
4. Bawa P. Retention in online courses: exploring issues and
Brianna Dowd
solutions e a literature review. Sage Open. 2016;6,
2158244015621777. Division of Trauma and Surgical Critical Care
5. Kayser C. Cultivating community-responsive future Department of Surgery
healthcare professionals: using service-learning in pre-health Kendall Regional Medical Center
humanities education. J Med Humanit. 2017;38:385e395. Miami, Florida
6. Vincent-Ruz P, Grabowski J, Schunn CD. The impact of early
participation in undergraduate research experiences on
Mark McKenney, MD, MBA, FACS
multiple measures of premed path success. Scholarship Pract
Undergraduate Res. 2018;1:13e18. Division of Trauma and Surgical Critical Care
7. Murphy B. How COVID-19 is affecting medical school admissions; Department of Surgery
2020. American Medical Association; 2020. Available at: Kendall Regional Medical Center
https://www.ama-assn.org/residents-students/preparing- Miami, Florida
medical-school/how-covid-19-affecting-medical-school- Department of Surgery
admissions. Accessed June 2, 2020.
University of South Florida
8. Rothenberger DA. Physician burnout and well-being: a
Tampa, Florida
systematic review and framework for action. Dis Colon Rectum.
2017;60:567e576.
9. Maloney A. Pearson VUE testing center closures. The Adel Elkbuli, MD, MPH*
American Board of Surgery. 2020. Available at: http://www. Division of Trauma and Surgical Critical Care
absurgery.org/default.jsp?news_covid19_ Department of Surgery
pearsonvueclosures. Accessed June 3, 2020.
Kendall Regional Medical Center
10. Coronavirus (COVID-19) and the MCAT exam. Association of
Miami, Florida
American Medical Colleges. 2020. Available at: https://
students-residents.aamc.org/applying-medical-school/ *Corresponding author. Division of Trauma and Surgical Critical
article/coronavirus-covid-19-and-mcat-exam/. Accessed June
Care, Department of Surgery, Kendall Regional Medical Cen-
3, 2020.
ter, 11750 Bird Road, Miami, FL 33175. Tel.: þ1 786 637 5287;
11. Campbell G. AAMC Press Teleconference. Association of
American Medical Colleges. 2020. Available at: https://www. fax: þ1 305 480 6625.
aamc.org/system/files/2020-05/ocomm-Teleconference- E-mail address: [email protected]
Transcript-2020.05.08.pdf. Accessed June 3, 2020.
12. Coronavirus (COVID-19) and AMCAS. Association of American
0022-4804/$ e see front matter
Medical Colleges. 2020. Available at: https://students-
ª 2020 Elsevier Inc. All rights reserved.
residents.aamc.org/applying-medical-school/article/
https://doi.org/10.1016/j.jss.2020.08.072
coronavirus-covid-19-and-amcas/. Accessed June 3, 2020.