Professionalism and mental health in medical and nursing students under prolonged virtual learning: a longitudinal study in Peru

BACKGROUND: After at least one year of virtual learning due to COVID‑19, medical and nursing faculties varied in their return to in‑person training. The absence of in‑person environments may have affected professionalism components such as empathy, teamwork, and lifelong learning abilities, while also impacting students' mental health and wellbeing. The objective of this study was to measure that effect. METHODS: A longitudinal study was conducted from 2020 to 2023 in the five medical and nursing faculties of Cusco, Peru. Two cohorts were followed: one with prolonged exposure to virtual learning and another with shorter exposure before resuming in‑person activities. Empathy (JSE), teamwork (JSAPNC), lifelong learning (JeffSPLL), depression (PHQ‑9), anxiety (GAD‑7), wellbeing (SWLS), and family loneliness (SELSA) were assessed with validated instruments, together with sociodemographic and academic variables. Analyses included reliability testing, paired and independent group comparisons, and multivariate regression models. RESULTS: A total of 417 students (233 medicine) completed both assessments; 137 (33%) had prolonged virtual exposure. Wellbeing was positively associated with lifelong learning, age, and shorter virtual exposure, but inversely with empathy and family loneliness. Risk of depression decreased with teamwork and in nursing students but increased in those enrolled in the clinical phase at baseline. Anxiety was associated with greater family loneliness, while a history of severe COVID‑19 illness was associated with lower risk. Students with shorter virtual exposure improved in empathy, teamwork, and learning abilities, whereas those with prolonged exposure did not. CONCLUSIONS: These findings indicate that prolonged reliance on virtual learning undermines professionalism‑related competencies, which are important for students' mental health and wellbeing. They also highlight the role of family support and the need for medical education to balance technology with in‑person training.