German medical students’ learning environment during the fading COVID-19 pandemic

Abstract Background The Medical School’s learning environment (MSLE) is important for medical students’ academic performance and mental well-being. COVID-19 disrupted medical education worldwide through restrictions on practical and in-person teaching. Although several studies have showcased the immediate effects on medical students’ perceptions of MSLE and mental well-being, less is known about the changes during the transition to post-pandemic medical education. Methods Four cross-sectional online surveys were conducted at a German medical school between winter 2021/2022 and summer 2023. MSLE was assessed using three items from the Johns Hopkins Learning Environment Scale (JHLES) and three self-developed items. Various validated items assessed distress (DT), perceived stress (PSS-4), depression (PHQ-2), anxiety (GAD-2), and loneliness (R-UCLA-3). Analyses included group comparisons and binary logistic regression. Results Across four survey waves, 687 individual medical and dental students participated. Positive MSLE perceptions were more frequent in later waves, although differences were not significant after correction for multiple comparisons. Social connectedness and access to mentoring were reported significantly more frequently in later waves. Higher age, more advanced study years, greater perceived stress, and perceived lack of practical experience were associated with lower odds of positive MSLE. The proportion reporting decreased study motivation since the onset of COVID-19 was significantly lower in the final wave. Older students, those in more advanced study years, and those experiencing loneliness or distress more frequently reported decreased motivation. Mental burden showed varying patterns: loneliness was generally lower in later waves, distress peaked in summer 2022, depressive symptoms and perceived stress in winter 2022/2023, and anxiety in summer 2023. After correction for multiple comparisons, only differences in distress across survey waves remained significant. Female students reported higher anxiety, loneliness, and perceived stress than male students, but only the gender difference in anxiety remained significant after correction. Conclusion Medical students reported a more positive perception of the MSLE in later survey waves during the transition from pandemic to post-pandemic medical education. However, these improvements were not matched by a uniform recovery in medical students’ well-being. Medical schools are therefore encouraged to strengthen students’ learning environments by ensuring learning opportunities, mentoring, and mental health support throughout training.