Medical students’ mental health, quality of life, motivation, and learning approaches before, during and after COVID-19: findings from a 4-wave repeated cross-sectional survey

This study examined changes in mental health, quality of life, academic motivation, and learning approaches before, during, and after the COVID-19, pandemic. The secondary objectives included identifying factors associated with these outcomes and investigating the mediating role of motivation in the relationship between learning approaches and mental health. This repeated cross-sectional survey included four distinct cohorts of medical students (n = 1,860) assessed in 2016, 2018, 2020, and 2022. Mental health (DASS-21), quality of life (WHOQOL-BREF), academic motivation (Academic Motivation Scale), and learning approaches (Revised Two-Factor Study Process Questionnaire) were used. Analyses included ANOVA, linear regression, and mediation models. While no significant differences in mental health were observed across cohorts, a positive trend emerged during the COVID-19 period, marked by increased deep learning, reduced surface learning, and higher scores in physical and environmental QoL compared with the other three non-COVID time points. Further, motivation was found to be higher during the COVID time point than in the pre-COVID (2018) period. The COVID-19 differences were further supported by linear regression, which showed that sex, age, income, ethnicity, stage of medical training, and study hours were associated with at least one of the assessed outcomes. Mediation models offered the additional insight that surface learning may increase amotivation, which, in turn, may result in worse mental health, whereas deep learning may have suppressive mediation. These findings underscore the importance of learning approaches in shaping motivation and mental health of medical students, showing that even in vulnerable situations, deeper learning approaches can minimize mental distress.