Nazarbayev University School of Medicine Master of Public Health Program

Nazarbayev University School of Medicine Master of Public Health Program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nazarbayev University School of Medicine Master of Public Health Program Nabiy Arystan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7506110/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background The COVID-19 pandemic has had a profound effect on the mental health of medical students worldwide. This study aimed to explore how Nazarbayev University medical students experienced and perceived these challenges during the pandemic. Methods A phenomenological qualitative design was applied. Ten students (five male, five female, aged 18–33) participated in semi-structured Zoom interviews between February and March 2022. Interviews were recorded, transcribed verbatim, and analyzed using Braun and Clarke’s thematic analysis framework. Results Four main themes were identified: (1) impacts on wellbeing, including anxiety, depression, burnout, insomnia, and loneliness; (2) effects on education, such as disrupted routines, increased workload, and difficulties with online learning; (3) coping mechanisms, with students relying mainly on family support, hobbies, and physical activity, while formal psychological support was rarely accessed; and (4) professional identity formation, where many students expressed increased social responsibility and engagement in volunteering. Participants emphasized concerns about infection risks, academic performance, reduced clinical practice opportunities, and uncertainty about the future. Conclusion The pandemic significantly affected medical students’ mental health, academic achievement, and professional development. Targeted interventions, mental health support, and improved educational strategies are needed to mitigate long-term consequences and better prepare students for future health crises. COVID-19 pandemic medical students mental health well-being coping strategies Kazakhstan Introduction Well-being is broadly defined as life satisfaction, fulfillment of potential, and the ability to function effectively (Diener et al., 2002 ). In mental health, it includes positive emotions, supportive relationships, and a sense of purpose (Keyes, 2005 ). The COVID-19 pandemic caused over 6 million deaths and 600 million infections globally (WHO, 2022), with widespread social and economic consequences such as isolation, financial stress, and disruption of education. Medical students have been especially vulnerable, reporting higher rates of anxiety and depression than the general population (Tam et al., 2016; Halperin et al., 2021 ). Stressors included online education, increased workload, loss of social interaction, and uncertainty about the future, often leading to depression, insomnia, or even suicidal ideation (Brenner et al., 2020). Studies worldwide confirm these patterns. Research in Europe, Asia, and the Middle East revealed high levels of anxiety, depression, and reduced motivation among medical and nursing students (Romeu-Labayen et al., 2022 ; Seetan et al., 2021 ; Villani et al., 2021; Sauer et al., 2022 ). Some reported specific challenges, such as lack of protective equipment, limited clinical training, and concern for family members. In Jordan, over 70% of students worried about their academic performance, social life, and physical fitness (Seetan et al., 2021 ). In Germany, 75% of students reported loneliness and low motivation (Holm-Hadulla, 2021). Women and minority groups were particularly at risk (Bennett et al., 2022 ; Zinchenko et al., 2021). Coping strategies varied. While some relied on positive thinking, meditation, or time management (Yusoff et al., 2021; Sahu et al., 2021), many turned to family support, physical activity, or hobbies (Seetan et al., 2021 ). Studies also noted altruistic responses, including volunteering and public health promotion (Singh & Bhoi, 2020 ). In Kazakhstan, limited research exists. One study examined students’ mental health across non-medical fields but did not address healthcare students specifically (Konstantinov et al., 2020). This gap highlights the importance of investigating the experiences of medical students in Kazakhstan. The present study addresses this gap by qualitatively exploring the wellbeing, educational challenges, coping strategies, and professional identity formation of Nazarbayev University medical students during the COVID-19 pandemic. Methods 2.1 Study Design A phenomenological qualitative design was used to explore medical students’ lived experiences during the COVID-19 pandemic, as phenomenology emphasizes the meaning derived from everyday life (Curran et al., 2001 ). 2.2 Data Collection Semi-structured in-depth interviews were conducted via Zoom between February 24 and March 12, 2022. Each interview lasted 20–45 minutes (mean 30). 2.3 Recruitment Participants were current Nazarbayev University medical students (bachelor’s, master’s, nursing, or MD) enrolled during the COVID-19 academic year (March 2020–December 2021). Invitations were distributed via mailing lists and social media. Ten students (five men, five women, aged 18–33) participated voluntarily after providing informed consent. No incentives were offered. Example questions addressed sleep disruption, academic workload, and the doctor’s role in addressing health inequities. 2.4 Data Analysis An inductive thematic analysis following Braun and Clarke’s ( 2006 ) six-phase framework was applied: familiarization with the data, coding, theme development, theme review, naming, and final reporting. The Nazarbayev University School of Medicine (NUSOM) ethic committee reviewed and approved this study. Results Ten individuals made up the research sample size: five men and five women, ranging in age from 18 to 33. Majors of participants: nursing, MD, master students. During the analysis of qualitative data, four themes were established, Table 3 displays these in a thematic table. Each theme is elaborated, explained, and evaluated extensively below, using quotes from the participants of the study as examples. Table 3 Thematic table of interview Theme Subtheme 1. The impact of Covid-19 on wellbeing; 1. Disruption to Sleep Patterns 2. Difficulty With Concentration 3. Concerns for One’s Own Health and the Health of Loved Ones 4. Increased Social Isolation 5. Changes in the Living Environment 2. The impact of Covid-19 on education: 1. Increased Class Workload 2. Concerns About Academic Performance 3. Impact on Clinical Practice 3.Coping Mechanism During COVID-19: 1. Seeking Support From Others 2. Seeking Professional Support During COVID-19 – and barriers to 4.The impact of Covid-19 on professional identity formation: 1. Awareness of social accountability 2. Awareness of global role of the doctor in addressing health inequities. 3. Becoming a member of the wider healthcare community 4. Appreciation of person-centered care 5. Awareness of personal needs and self-care Theme 1. The impact of Covid-19 on wellbeing; Disruption to Sleep Patterns. Most part of participant’s reports suffering from insomnia within quarantine measures attributable to them not have opportunities for physical activity. Also, most participants reported that changes related to daily regimen which led to problem with quality of sleep. “Sleep was badly spoiled because the work and sleep regime was disrupted. I often fell asleep at 4 in the morning and woke up at 8 or 9. During the pandemic, I became addicted to coffee, which helped me to be in good shape throughout the day. I drank about a liter of coffee a day. In my opinion, the absence of my usual lifestyle has greatly affected the quality and duration of sleep. Before the pandemic, there were no problems with sleep” (P2, male) Just one participant had more qualitative sleep within the pandemic but after decrease the outbreak when she should visit the lessons in-person, she had some problems with sleep pattern “In fact, during the pandemic, I slept more and the quality of sleep was quite good. I didn't have to spend time packing, driving to the university. Before the pandemic, I had no problems sleeping, but after the pandemic ended and we had to study offline, I had insomnia. I suppose because I got used to the mode when studying was online” (P9, female). Difficulty With Concentration. Also, most student’s highlight that concentration of attention worsen. However, on participant consider that it connected to sleep pattern because they did not sleep enough while some people think the main reason of poor concentration is coronavirus which impacts to nervous system of human. “As a result of my illness, my memory, attention and some cognitive functions deteriorated. In medicine, this is called bridge syndrome. In my case, it lasted about six months, possibly more. I have conducted some literature review about the problem and I have concluded that the virus smite nervous system” (P6, male). Concerns for One’s Own Health and the Health of Loved Ones. Regarding to this subtheme, all students mostly concerned about their parents and relatives, not about own healthcare. “The fear was for the relatives, since they are not young either. But I explained the basic skills, how not to get infected as much as possible, how to maintain the healthy state that they have. And I think by explaining the basic habits that need to be followed. It helped them that they did not get sick with the virus, and, thank God, there were no losses.” (P1, female). Increased Social Isolation .There are several opinions related to the aspect. To be more precise some students consider that self-isolation was opportunity to self-development while others thought it was serious challenge because that did have familiar physical activity, communication, and mode of education. Some participants consider that self-isolation was not so problematic. “In my opinion, self-isolation can affect anyone in some cases. It is essential for individuals dealing with social isolation to have self-care strategies. However, I felt normal, since I understood that it is only a temporary process and we need to stay healthy both mentally and physically” (P5, female). Some participants the self-isolation was so destructive “During the period of self-isolation, I was at home for 4 months. I lived in a private house and occasionally went out into the yard to get some fresh air, but I did not go outside the yard. I am an extrovert and communication with people is very important to me.. Against this background, I was emotionally burned out and therefore my academic performance decreased (I failed three subjects). The only way to distract myself somehow was music. At that time I started writing songs, by the way, this is what I am doing to this day” (P2, male). However, we can see some people consider the self-isolation was useful for them and they found some opportunity to increase own competence as professional and and in other areas. "To be honest, social isolation did not have a negative impact on me, it affected to me positively. Before the pandemic, I spent a lot of time travelling, preparing for my classes, and studying. Sometimes, I did not have time to do sport and physical activity. However, during the pandemic, I had more free time. I completed a bunch of courses and there were many other types of such courses on the internet. I focused only on myself and devoted 100% of my time to myself. I studied very well and all of this helped me in furthering my work, studies and self-improvement." (P1, female). Changes in the Living Environment .Regarding to the subtheme we can see that living environment was approximately equal for each students due quarantine measures, self-isolation, online education and other factors. “During the quarantine period, we MD students lived in a dormitory, because we needed clinical practice, visits to hospitals, simulation centers, etc. The dorm was almost empty, everyone lived separately one by one. There were constant controls, in the form of measuring body temperature, taking PCR tests, wearing masks and other things. At that moment, isolation was felt very strongly, which was absolutely unusual for me. I always had to cook myself and bring food with me” (P4, male). For those who lived at home within quarantine the environment was some boring “Yes, my living environment changed during the pandemic. Mostly, I felt loneliness in terms of professionality, with my colleagues we met only through the zoom platform” (P5, female). Also, we should pay attention for living conditions of students which could be serious reason of mental disorder like irritability, anxiety “During the period of self-isolation, I was constantly under stress. Because we lived in a small apartment and often did not have enough space to study. I often had to go to the balcony to study. I became more irritable” (P9, female). Theme 2. The impact of Covid-19 on education : Increased Class Workload. Most students consider that online education was not familiar and so they spent more time to studying. “The academic load has definitely increased during the pandemic. We've had to adjust to online learning and have had to take on more responsibility for our own education. It has been a challenging time, and it has been difficult to stay on top of everything” (P7, male) However, other circumstances could be problem in online education “The workload got bigger because I wasn't used to studying online, I had to spend more time studying and learning new material. Some family circumstances have affected my academic performance”(P1, male). Sometimes it could be connected to technical aspects “During the pandemic, the academic load has changed in terms of we all studying online. Studying online has some drawbacks. For instance, all students need to have a computer and good internet. If the student had a bad internet connection it also affected the education process” (P5, female). Concerns About Academic Performance. Most students experienced concerns about academic performance within the pandemic and online education Without a doubt, online studying had some difficulties. There were even some subjects that I didn't comprehend at all, despite attending classes.. Meanwhile, I sat alone, not understanding anything and feeling like I didn't have enough time. (P1, female). One of the main reason of anxiety was unfamiliar mode of education “Yes, I have had some anxiety and concerns about my academic performance during the pandemic. It's been difficult to adapt to the new way of learning, and I worry about falling behind or not doing as well as I could” (P1, male). However, some students have the opposite opinion i.e. they were satisfied online education and did not have any problems with it “There was no anxiety about academic performance, because I received all the necessary information in full, even if the course was online. For me, there was no difference in which mode the training takes place” (P4, male). Impact on Clinical Practice. It closely depended on major of student and student`s year because some program do not need clinical practice such as Public Health. Also, students Phramacy and Toxicology do not need clinical practice but they need lab experiment. In addition, some students have studied in first year and so they did not need clinical or lab practice. “Fortunately, during the pandemic, I was a first-year student and there was no need for clinical practice. Most of the courses were theoretical. But online training did not give me the knowledge that would be necessary. I think online learning is extremely inefficient, especially for medical students” (P2, male). Theme 3. Coping Mechanism During COVID-19 Seeking Support From Others. We can see that almost all students taken mental support from own family and friends “Yes, I have needed the support of others during this time. My family has been a great source of support for me, and I've also connected with friends virtually. It has been helpful to have people to talk to and share my experiences with” (P5, female) Other students argued that friend`s support was enough "The person who supported me the most was my friend. Although I am brought up to tell my parents about my problems in case of emergency, at that moment, it seemed to me that I would be able to get out of that mental state on my own." (P2, male). Seeking Professional Support During COVID-19 – and barriers to . Although some people needed mental support by psychologists and psychotherapists but they could not get it because they did not have any money for the therapy while psychologists provided by University always was busy and unavailable “ In fact, I often had a desire to turn to a psychologist or psychotherapist. Unfortunately, I do not have the financial resources to afford a qualified specialist. As for psychologists or psychotherapists at our university, it is extremely difficult to enroll there. You need to take a queue several months in advance” (P9, female). So, we can see that all students tried to avoid mental disorders without specialists using hobby “I did not need any mental support because I am highly motivated person and read many books in terms of psychology” (P5, female) Most students consider that hobby like music was so effective copying strategy during the pandemic The only way to distract myself somehow was music. At that time I started writing songs, by the way, this is what I am doing to this day” (P2, male). Theme 4. The impact of Covid-19 on professional identity formation : Awareness of social accountability. Each students variously expressed about it within the pandemic. All students considered it their duty to protect their parents and relatives by informing them about precautionary measures. Many saw this as their social responsibility “Sure. The most important thing is to protect yourself and your family. Only my husband went to the store, he was always wearing a mask. He washed his hands before and after visiting the store. And I was sitting at home keeping clean, airing the rooms. My husband knew that in a public place it is very important not to touch the mask or face with your hands, to keep a distance. We didn't go outside unless necessary”. (P9, female). Also, we can see that some students expressed social accountability more actively “At that moment, I decided to become a volunteer in a mobile hospital. I worked there for about three months, I had to do far from the cleanest work, such as washing dead people, hygiene of patients. I also translated medical scientific articles, helped to compile protocols. I was also engaged in the sale of masks at discounted prices, almost two times lower than the market. I thought it was my duty as a citizen and a medic” (P1, male) Some students expressed own social responsibility as be quality specialist in own work “At that time, the main thing for me was not to harm, i.e. I followed all precautions to minimize the risk of infecting someone. Also, during the internship, I diligently performed my duties as an intern, sometimes during the practice we performed the duties of a doctor to some extent because there were not enough medical personnel” (P4, male) Awareness of global role of the doctor in addressing health inequities. Regarding to the part there are two opinions. Some students consider that doctor play a key role in this issue “Of course, the role of the doctor was the most important during the covid period. But I think it was a certain underestimation of nurses and brothers. Sometimes they contribute more contribution to saving a person than a doctor” (P2, male) While others think problem of inequity closely connected to other intuitions like ministry or department of healthcare, heads of medical organizations. “It seems to me that the role of the doctor in the inequality of the distribution of medical care was not the most significant. At that moment there was a very huge flow of infected people who needed hospitalization. It seems to me that the Ministry and health departments, not ordinary doctors, played a big role in solving this problem” (P4, male). Important highlight that, it was hard question for many students. “It is very difficult to answer this question. If he is alone, and there are many patients, then he decides to help someone who really needs emergency care. Inequality in medicine is an acute issue. And the pandemic just revealed these gaps in medicine. One doctor will not be able to physically help everyone, despite his desire” (P8, female) Becoming a member of the wider healthcare community. The item is one of the interesting for participants but predominantly students answered for the questions negatively, said “No”. No. During the pandemic, I didn't consider myself a member of the wider medical community. My task at that time was to protect myself and my loved ones from the virus. I could only warn my friends and family about social responsibility, about the importance of isolation (P8, female). The participant who consider they argument own position by following statements “At that moment, I decided to become a volunteer in a mobile hospital. I worked there for about three months, I had to do far from the cleanest work, such as washing dead people, hygiene of patients. I also translated medical scientific articles, helped to compile protocols. I was also engaged in the sale of masks at discounted prices, almost two times lower than the market. I thought it was my duty as a citizen and a medic” (P1, male) Appreciation of person-centered care was hard question for each participant. Large part of students think that they could not avoid bias in this question due different circumstances such as personal point of view, cultural and others. Although they consider that we should try to be more objective and follow ethical norms. “I don't want to lie, but it seems to me that I would be more attentive to the patient who is a relative for me. I think there's nothing you can do about it, that's human nature. Also, there are other opinion related to the item “I think patient orientation is very important for a healthcare professional. The main goal is not to harm the patient, but to lead him to improvement or recovery. All patients are different. Therefore, the doctor should have an individual approach to each patient” (P8, female) Awareness of personal needs and self-care. We can see all participant expressed the similar point of view regarding to the question “My awareness of personal needs has improved since the pandemic. First of all, you need to take care of your health. Because without health, you can't take care of your loved ones. For example, how can a mother take care of her child if she is sick? Therefore, first of all you need to take care of yourself and monitor your health” (P8, female). Discussion This study employed a qualitative approach to explore the experiences of Nazarbayev University medical students during the COVID-19 pandemic. Four themes emerged: wellbeing, education, coping strategies, and professional identity formation. Anxiety was widespread, and about half of students reported insomnia and emotional burnout, largely linked to stress, workload, and isolation. Loneliness was a frequent concern, consistent with Holm-Hadulla’s finding that 75% of students experienced social isolation leading to poor motivation and depression. Students described sadness, worry, disrupted routines, and fear of infection, a phenomenon also referred to as “Coronaphobia” (Kanekar & Sharma, 2020). These symptoms often persisted beyond the initial lockdown, as seen in other epidemics (Serafini et al., 2020 ). Female students reported more severe anxiety and depression, echoing findings by Bennett et al. and Villani et al. (2021), highlighting the need for gender-sensitive support. Positive effects were also noted. Many students spent more time with family, adopted hobbies, or deepened their studies. However, depression, anxiety, sleep disturbances, and overeating still impaired academic performance (Brenner et al., 2020). Concerns about parents’ health were common (Seetan et al., 2021 ). Some students attributed their symptoms to disrupted routines, others to post-COVID neurological effects such as memory and concentration decline. Social isolation further harmed wellbeing, particularly for those living alone or in dormitories. Limited workspace, lack of direct communication with faculty, and online education reduced motivation. Most students perceived online learning as burdensome, though some appreciated its flexibility and efficiency. Key barriers included poor internet, distractions at home, and limited opportunities for discussion. Clinical practice was particularly disrupted for MD and nursing students, while first-year and public health students were less affected. Coping strategies relied heavily on family and peer support, hobbies, exercise, and self-study. Few accessed professional psychological services due to financial or institutional barriers. This differs from studies emphasizing meditation and time management (Yusoff et al., 2021; Sahu et al., 2021). Despite challenges, students demonstrated altruism through volunteering, donations, and adherence to preventive measures. Professional identity was shaped by heightened social responsibility. Some volunteered in COVID-19 hospitals, others educated relatives and peers. Views diverged on doctors’ role in addressing health inequities: some saw them as central, while others emphasized systemic decisions by health authorities. Students who volunteered felt part of the wider medical community, though others saw this as an overstatement of their role. Patient-centered care raised ethical dilemmas: while students valued equal treatment, many admitted they might prioritize relatives due to cultural or personal biases. All emphasized greater awareness of self-care and the need to protect one’s health to serve others. Strengths and Limitations A key strength of this qualitative design was its ability to capture nuanced experiences beyond survey data. The inclusion of students from different disciplines and backgrounds provided diversity of perspectives. Limitations include the short study period and lack of baseline mental health data, making it difficult to attribute all outcomes solely to the pandemic. Conclusion The COVID-19 pandemic created significant challenges for medical students’ mental health and wellbeing, marked by high levels of stress, anxiety, insomnia, and burnout. Female students reported greater vulnerability, underscoring the need for gender-sensitive support. Our findings align with previous studies on mental health, academic disruption, and social responsibility, while also revealing unique coping strategies. Unlike international research that emphasized meditation and time management, participants in this study relied more on communication, family support, and physical activity. In addition, several novel themes emerged, including awareness of doctors’ role in addressing health inequities, the sense of belonging to the wider healthcare community, person-centered care, and increased attention to self-care. These results confirm both shared and distinctive experiences of medical students in Kazakhstan, highlighting the importance of tailored interventions and the need for further qualitative research to explore long-term impacts and effective support strategies. Declarations Ethics approval and consent to participate This study was approved by the Institutional Research Ethics Committee (IREC) of Nazarbayev University School of Medicine. The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. A copy of the ethics approval is available with the corresponding author. Consent for publication Not applicable. Competing interests The author declares no competing interests. Authors’ information (optional) Nabiy Arystan is a PhD student in Global Health at Nazarbayev University School of Medicine, Kazakhstan. Funding Not applicable. Author Contribution Nabiy Arystan conceptualized and designed the study, developed the methodology, conducted data collection, and performed the qualitative analysis. Nabiy Arystan also interpreted the findings, drafted the manuscript, and revised it critically for important intellectual content. The author is solely responsible for all aspects of the work and has approved the final version of the manuscript. Acknowledgement The author would like to acknowledge Professor Faye Foster for her valuable guidance and constructive feedback during the preparation of this manuscript. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Bennett J, Heron JE, Gunnell DJ, Purdy S, Linton M-J. The impact of the COVID-19 pandemic on student mental health and wellbeing in UK university students: a multiyear crosssectional analysis. J Mental Health. 2022;31(4):597–604. https://doi.org/10.1080/09638237.2022.2091766 . Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101. Brenner MH, Bhugra D. Acceleration of Anxiety, Depression, and Suicide: Secondary Effects of Economic Disruption Related to COVID-19. Front Psychiatry. 2020;11:592467. doi: 10.3389/fpsyt.2020.592467. Erratum in: Front Psychiatry. 2021;12:660659. PMID: 33384627; PMCID: PMC7771384. Cacciatore M, Raggi A, Pilotto A, Cristillo V, Guastafierro E, Toppo C, Magnani FG, Sattin D, Mariniello A, Silvaggi F, Cotti Piccinelli S, Zoppi N, Bonzi G, Gipponi S, Libri I, Bezzi M, Martelletti P, Leonardi M, Padovani A. Neurological and Mental Health Symptoms Associated with Post-COVID-19 Disability in a Sample of Patients Discharged from a COVID-19 Ward: A Secondary Analysis. Int J Environ Res Public Health. 2022;19(7):4242. 10.3390/ijerph19074242 . PMID: 35409924; PMCID: PMC8998950. Curran PJ, West SG, Finch JF. The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychol Methods. 2001;6(1):3–20. 10.1037/1082-989X.6.1.3 . Diener E, Lucas RE, Oishi S. Subjective well-being: The science of happiness and life satisfaction. In: Snyder CR, Lopez S, editors. Handbook of Positive Psychology. New York: Oxford University Press; 2002. pp. 63–73. Halperin SJ, Henderson MN, Prenner S, Grauer JN. Prevalence of Anxiety and Depression Among Medical Students During the Covid-19 Pandemic: A Cross-Sectional Study. J Med Educ Curric Dev. 2021;8:2382120521991150. PMID: 33644399; PMCID: PMC7890732. Konstantinov V, Berdenova S, Satkangulova G, et al. COVID-19 Impact on Kazakhstan University Student Fear, Mental Health, and Substance Use. Int J Ment Health Addict. 2022;20:888–94. https://doi.org/10.1007/s11469-020-00412-y . Keyes CLM. Mental illness and/or mental health? Investigating axioms of the complete state model of health. J Consult Clin Psychol. 2005;73(3):539–48. 10.1037/0022-006X.73.3.539 . Tam MW, W. W., Ho RC. Prevalence of depression amongst medical students: A meta-analysis. Med Educ. 2016;50(4):456–68. O'Connor RC, Wetherall K, Cleare S, McClelland H, Melson AJ, Niedzwiedz CL, O'Carroll RE, O'Connor DB, Platt S, Scowcroft E, Watson B, Zortea T, Ferguson E, Robb KA. Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study. Br J psychiatry: J mental Sci. 2021;218(6):326–33. https://doi.org/10.1192/bjp.2020.212 . Pfefferbaum B, North CS. Mental health and the Covid-19 pandemic. N Engl J Med. 2020;383(6):510–2. Romeu-Labayen M, Tort-Nasarre G, Alvarez B, Subias-Miquel M, Vázquez-Segura E, Marre D, Galbany-Estragués P. Spanish nurses' experiences with personal protective equipment and perceptions of risk of contagion from COVID-19: A qualitative rapid appraisal. J Clin Nurs. 2022;31(15–16):2154–66. Epub 2021 Sep 15. PMID: 34528310; PMCID: PMC8662180. Serafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M. The psychological impact of COVID-19 on the mental health in the general population. QJM: Int J Med. 2020;113(8):531–7. Singh S, Bhoi AK. Social responsibility of medical students in COVID-19 pandemic. J Med Educ Curric Dev. 2020;7:2382120520951814. https://doi.org/10.1177/2382120520951814 . Sauer N, Sałek A, Szlasa W, Ciecieląg T, Obara J, Gaweł S, Marciniak D et al. (2022). The Impact of COVID-19 on the Mental Well-Being of College Students. International Journal of Environmental Research and Public Health , 19 (9), 5089. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph19095089 Seetan K, Al-Zubi M, Rubbai Y, Athamneh M, Khamees A, Radaideh T. Impact of COVID-19 on medical students' mental wellbeing in Jordan. PLoS ONE. 2021;16(6):e0253295. 10.1371/journal.pone.0253295 . PMID: 34138964; PMCID: PMC8211263. WHO Coronavirus (COVID-19). Dashboard. (n.d.). With Vaccination Data. https://covid19.who.int/ Xiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, McIntyre RS. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord. 2020;277:55–64. Additional Declarations No competing interests reported. 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Arystan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYFACHoYDCE4FmDRgQBbDo4UZiM8QqYUBroWxjQgt5uxnDx7mYbDLNzh//uDnwnl3EhvYm7dJMJypw6nFsicvAagl2XLDjWRm6ZnbniU28Bwrk2C4wYZTi8GBHAOgFmYDgxvMDNK82w4nNkjkmEkwfODBreX8G5CWegOD84eZf/POAWqRfwPSIoFbyw2wLYcNDA4ks0nzNoBs4QFquWGAR8u7hINzDI4bSN5INrPmOXbYuI0nrdgi4UwCHoflHv7wpqLagO/8wce3eWoOy/azH95448Mx3CEGAkw8QFcoHIDywEGF2w4IYPwBJOQbCKgaBaNgFIyCkQsA5PJWCBQBq+IAAAAASUVORK5CYII=","orcid":"","institution":"Nazarbayev University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Nabiy","middleName":"","lastName":"Arystan","suffix":""}],"badges":[],"createdAt":"2025-09-01 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In mental health, it includes positive emotions, supportive relationships, and a sense of purpose (Keyes, \u003cspan class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe COVID-19 pandemic caused over 6\u0026nbsp;million deaths and 600\u0026nbsp;million infections globally (WHO, 2022), with widespread social and economic consequences such as isolation, financial stress, and disruption of education. Medical students have been especially vulnerable, reporting higher rates of anxiety and depression than the general population (Tam et al., 2016; Halperin et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Stressors included online education, increased workload, loss of social interaction, and uncertainty about the future, often leading to depression, insomnia, or even suicidal ideation (Brenner et al., 2020).\u003c/p\u003e\n\u003cp\u003eStudies worldwide confirm these patterns. Research in Europe, Asia, and the Middle East revealed high levels of anxiety, depression, and reduced motivation among medical and nursing students (Romeu-Labayen et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e; Seetan et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e; Villani et al., 2021; Sauer et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Some reported specific challenges, such as lack of protective equipment, limited clinical training, and concern for family members. In Jordan, over 70% of students worried about their academic performance, social life, and physical fitness (Seetan et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). In Germany, 75% of students reported loneliness and low motivation (Holm-Hadulla, 2021). Women and minority groups were particularly at risk (Bennett et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e; Zinchenko et al., 2021).\u003c/p\u003e\n\u003cp\u003eCoping strategies varied. While some relied on positive thinking, meditation, or time management (Yusoff et al., 2021; Sahu et al., 2021), many turned to family support, physical activity, or hobbies (Seetan et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Studies also noted altruistic responses, including volunteering and public health promotion (Singh \u0026amp; Bhoi, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn Kazakhstan, limited research exists. One study examined students\u0026rsquo; mental health across non-medical fields but did not address healthcare students specifically (Konstantinov et al., 2020). This gap highlights the importance of investigating the experiences of medical students in Kazakhstan.\u003c/p\u003e\n\u003cp\u003eThe present study addresses this gap by qualitatively exploring the wellbeing, educational challenges, coping strategies, and professional identity formation of Nazarbayev University medical students during the COVID-19 pandemic.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study Design\u003c/strong\u003eA phenomenological qualitative design was used to explore medical students\u0026rsquo; lived experiences during the COVID-19 pandemic, as phenomenology emphasizes the meaning derived from everyday life (Curran et al., \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Data Collection\u003c/strong\u003eSemi-structured in-depth interviews were conducted via Zoom between February 24 and March 12, 2022. Each interview lasted 20\u0026ndash;45 minutes (mean 30).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Recruitment\u003c/strong\u003eParticipants were current Nazarbayev University medical students (bachelor\u0026rsquo;s, master\u0026rsquo;s, nursing, or MD) enrolled during the COVID-19 academic year (March 2020\u0026ndash;December 2021). Invitations were distributed via mailing lists and social media. Ten students (five men, five women, aged 18\u0026ndash;33) participated voluntarily after providing informed consent. No incentives were offered. Example questions addressed sleep disruption, academic workload, and the doctor\u0026rsquo;s role in addressing health inequities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Data Analysis\u003c/strong\u003eAn inductive thematic analysis following Braun and Clarke\u0026rsquo;s (\u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e) six-phase framework was applied: familiarization with the data, coding, theme development, theme review, naming, and final reporting.\u003c/p\u003e\n\u003cp\u003eThe Nazarbayev University School of Medicine (NUSOM) ethic committee reviewed and approved this study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTen individuals made up the research sample size: five men and five women, ranging in age from 18 to 33. Majors of participants: nursing, MD, master students.\u003c/p\u003e\n\u003cp\u003eDuring the analysis of qualitative data, four themes were established, Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e displays these in a thematic table. Each theme is elaborated, explained, and evaluated extensively below, using quotes from the participants of the study as examples.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThematic table of interview\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTheme\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSubtheme\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.\u0026nbsp;The impact of Covid-19 on wellbeing;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.\u0026nbsp; Disruption to Sleep Patterns\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; Difficulty With Concentration\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; Concerns for One\u0026rsquo;s Own Health and the Health of Loved Ones\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; Increased Social Isolation\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp;Changes in the Living Environment\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.\u0026nbsp;The impact of Covid-19 on education:\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1. Increased Class Workload\u003c/p\u003e\n\u003cp\u003e2. Concerns About Academic Performance\u003c/p\u003e\n\u003cp\u003e3. Impact on Clinical Practice\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.Coping Mechanism During COVID-19:\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1. Seeking Support From Others\u003c/p\u003e\n\u003cp\u003e2. Seeking Professional Support During COVID-19 \u0026ndash; and barriers to\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.The impact of Covid-19 on professional identity formation:\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1. Awareness of social accountability\u003c/p\u003e\n\u003cp\u003e2. Awareness of global role of the doctor in addressing health inequities.\u003c/p\u003e\n\u003cp\u003e3. Becoming a member of the wider healthcare community\u003c/p\u003e\n\u003cp\u003e4. Appreciation of person-centered care\u003c/p\u003e\n\u003cp\u003e5. Awareness of personal needs and self-care\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1. The impact of Covid-19 on wellbeing;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDisruption to Sleep Patterns.\u003c/strong\u003e Most part of participant\u0026rsquo;s reports suffering from insomnia within quarantine measures attributable to them not have opportunities for physical activity. Also, most participants reported that changes related to daily regimen which led to problem with quality of sleep.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Sleep was badly spoiled because the work and sleep regime was disrupted. I often fell asleep at 4 in the morning and woke up at 8 or 9. During the pandemic, I became addicted to coffee, which helped me to be in good shape throughout the day. I drank about a liter of coffee a day. In my opinion, the absence of my usual lifestyle has greatly affected the quality and duration of sleep. Before the pandemic, there were no problems with sleep\u0026rdquo;\u003c/em\u003e (P2, male)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJust one participant had more qualitative sleep within the pandemic but after decrease the outbreak when she should visit the lessons in-person, she had some problems with sleep pattern\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In fact, during the pandemic, I slept more and the quality of sleep was quite good. I didn't have to spend time packing, driving to the university. Before the pandemic, I had no problems sleeping, but after the pandemic ended and we had to study offline, I had insomnia. I suppose because I got used to the mode when studying was online\u0026rdquo;\u003c/em\u003e (P9, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDifficulty With Concentration.\u003c/strong\u003e Also, most student\u0026rsquo;s highlight that concentration of attention worsen. However, on participant consider that it connected to sleep pattern because they did not sleep enough while some people think the main reason of poor concentration is coronavirus which impacts to nervous system of human.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;As a result of my illness, my memory, attention and some cognitive functions deteriorated. In medicine, this is called bridge syndrome. In my case, it lasted about six months, possibly more. I have conducted some literature review about the problem and I have concluded that the virus smite nervous system\u0026rdquo;\u003c/em\u003e (P6, male).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eConcerns for One\u0026rsquo;s Own Health and the Health of Loved Ones.\u003c/strong\u003e Regarding to this subtheme, all students mostly concerned about their parents and relatives, not about own healthcare.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The fear was for the relatives, since they are not young either. But I explained the basic skills, how not to get infected as much as possible, how to maintain the healthy state that they have. And I think by explaining the basic habits that need to be followed. It helped them that they did not get sick with the virus, and, thank God, there were no losses.\u0026rdquo;\u003c/em\u003e (P1, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eIncreased Social Isolation\u003c/strong\u003e .There are several opinions related to the aspect. To be more precise some students consider that self-isolation was opportunity to self-development while others thought it was serious challenge because that did have familiar physical activity, communication, and mode of education.\u003c/p\u003e\n\u003cp\u003eSome participants consider that self-isolation was not so problematic.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In my opinion, self-isolation can affect anyone in some cases. It is essential for individuals dealing with social isolation to have self-care strategies. However, I felt normal, since I understood that it is only a temporary process and we need to stay healthy both mentally and physically\u0026rdquo;\u003c/em\u003e (P5, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSome participants the self-isolation was so destructive\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During the period of self-isolation, I was at home for 4 months. I lived in a private house and occasionally went out into the yard to get some fresh air, but I did not go outside the yard. I am an extrovert and communication with people is very important to me.. Against this background, I was emotionally burned out and therefore my academic performance decreased (I failed three subjects). The only way to distract myself somehow was music. At that time I started writing songs, by the way, this is what I am doing to this day\u0026rdquo;\u003c/em\u003e (P2, male).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eHowever, we can see some people consider the self-isolation was useful for them and they found some opportunity to increase own competence as professional and and in other areas.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\"To be honest, social isolation did not have a negative impact on me, it affected to me positively. Before the pandemic, I spent a lot of time travelling, preparing for my classes, and studying. Sometimes, I did not have time to do sport and physical activity. However, during the pandemic, I had more free time. I completed a bunch of courses and there were many other types of such courses on the internet. I focused only on myself and devoted 100% of my time to myself. I studied very well and all of this helped me in furthering my work, studies and self-improvement.\"\u003c/em\u003e (P1, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eChanges in the Living Environment\u003c/strong\u003e .Regarding to the subtheme we can see that living environment was approximately equal for each students due quarantine measures, self-isolation, online education and other factors.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During the quarantine period, we MD students lived in a dormitory, because we needed clinical practice, visits to hospitals, simulation centers, etc. The dorm was almost empty, everyone lived separately one by one. There were constant controls, in the form of measuring body temperature, taking PCR tests, wearing masks and other things. At that moment, isolation was felt very strongly, which was absolutely unusual for me. I always had to cook myself and bring food with me\u0026rdquo;\u003c/em\u003e (P4, male).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eFor those who lived at home within quarantine the environment was some boring\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, my living environment changed during the pandemic. Mostly, I felt loneliness in terms of professionality, with my colleagues we met only through the zoom platform\u0026rdquo;\u003c/em\u003e (P5, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eAlso, we should pay attention for living conditions of students which could be serious reason of mental disorder like irritability, anxiety\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During the period of self-isolation, I was constantly under stress. Because we lived in a small apartment and often did not have enough space to study. I often had to go to the balcony to study. I became more irritable\u0026rdquo;\u003c/em\u003e (P9, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2. The impact of Covid-19 on education\u003c/strong\u003e:\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eIncreased Class Workload.\u003c/strong\u003e Most students consider that online education was not familiar and so they spent more time to studying.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The academic load has definitely increased during the pandemic. We've had to adjust to online learning and have had to take on more responsibility for our own education. It has been a challenging time, and it has been difficult to stay on top of everything\u0026rdquo; (P7, male)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eHowever, other circumstances could be problem in online education\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The workload got bigger because I wasn't used to studying online, I had to spend more time studying and learning new material. Some family circumstances have affected my academic performance\u0026rdquo;(P1, male).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSometimes it could be connected to technical aspects\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During the pandemic, the academic load has changed in terms of we all studying online. Studying online has some drawbacks. For instance, all students need to have a computer and good internet. If the student had a bad internet connection it also affected the education process\u0026rdquo;\u003c/em\u003e (P5, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eConcerns About Academic Performance.\u003c/strong\u003e Most students experienced concerns about academic performance within the pandemic and online education\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eWithout a doubt, online studying had some difficulties. There were even some subjects that I didn't comprehend at all, despite attending classes.. Meanwhile, I sat alone, not understanding anything and feeling like I didn't have enough time. (P1, female).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eOne of the main reason of anxiety was unfamiliar mode of education\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, I have had some anxiety and concerns about my academic performance during the pandemic. It's been difficult to adapt to the new way of learning, and I worry about falling behind or not doing as well as I could\u0026rdquo;\u003c/em\u003e (P1, male).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eHowever, some students have the opposite opinion i.e. they were satisfied online education and did not have any problems with it\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There was no anxiety about academic performance, because I received all the necessary information in full, even if the course was online. For me, there was no difference in which mode the training takes place\u0026rdquo;\u003c/em\u003e (P4, male).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eImpact on Clinical Practice.\u003c/strong\u003e It closely depended on major of student and student`s year because some program do not need clinical practice such as Public Health. Also, students Phramacy and Toxicology do not need clinical practice but they need lab experiment. In addition, some students have studied in first year and so they did not need clinical or lab practice.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Fortunately, during the pandemic, I was a first-year student and there was no need for clinical practice. Most of the courses were theoretical. But online training did not give me the knowledge that would be necessary. I think online learning is extremely inefficient, especially for medical students\u0026rdquo;\u003c/em\u003e (P2, male).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eTheme 3. Coping Mechanism During COVID-19\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eSeeking Support From Others.\u003c/strong\u003e We can see that almost all students taken mental support from own family and friends\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, I have needed the support of others during this time. My family has been a great source of support for me, and I've also connected with friends virtually. It has been helpful to have people to talk to and share my experiences with\u0026rdquo; (P5, female)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eOther students argued that friend`s support was enough\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\"The person who supported me the most was my friend. Although I am brought up to tell my parents about my problems in case of emergency, at that moment, it seemed to me that I would be able to get out of that mental state on my own.\"\u003c/em\u003e (P2, male).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSeeking Professional Support During COVID-19 \u0026ndash; and barriers to\u003c/strong\u003e. Although some people needed mental support by psychologists and psychotherapists but they could not get it because they did not have any money for the therapy while psychologists provided by University always was busy and unavailable\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eIn fact, I often had a desire to turn to a psychologist or psychotherapist. Unfortunately, I do not have the financial resources to afford a qualified specialist. As for psychologists or psychotherapists at our university, it is extremely difficult to enroll there. You need to take a queue several months in advance\u0026rdquo;\u003c/em\u003e (P9, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSo, we can see that all students tried to avoid mental disorders without specialists using hobby\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I did not need any mental support because I am highly motivated person and read many books in terms of psychology\u0026rdquo;\u003c/em\u003e (P5, female)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eMost students consider that hobby like music was so effective copying strategy during the pandemic\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe only way to distract myself somehow was music. At that time I started writing songs, by the way, this is what I am doing to this day\u0026rdquo;\u003c/em\u003e (P2, male).\u003c/p\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cstrong\u003eTheme 4. The impact of Covid-19 on professional identity formation\u003c/strong\u003e:\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAwareness of social accountability.\u003c/strong\u003e Each students variously expressed about it within the pandemic. All students considered it their duty to protect their parents and relatives by informing them about precautionary measures. Many saw this as their social responsibility\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Sure. The most important thing is to protect yourself and your family. Only my husband went to the store, he was always wearing a mask. He washed his hands before and after visiting the store. And I was sitting at home keeping clean, airing the rooms. My husband knew that in a public place it is very important not to touch the mask or face with your hands, to keep a distance. We didn't go outside unless necessary\u0026rdquo;.\u003c/em\u003e (P9, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eAlso, we can see that some students expressed social accountability more actively\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;At that moment, I decided to become a volunteer in a mobile hospital. I worked there for about three months, I had to do far from the cleanest work, such as washing dead people, hygiene of patients. I also translated medical scientific articles, helped to compile protocols. I was also engaged in the sale of masks at discounted prices, almost two times lower than the market. I thought it was my duty as a citizen and a medic\u0026rdquo;\u003c/em\u003e (P1, male)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eSome students expressed own social responsibility as be quality specialist in own work\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;At that time, the main thing for me was not to harm, i.e. I followed all precautions to minimize the risk of infecting someone. Also, during the internship, I diligently performed my duties as an intern, sometimes during the practice we performed the duties of a doctor to some extent because there were not enough medical personnel\u0026rdquo; (P4, male)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAwareness of global role of the doctor in addressing health inequities.\u003c/strong\u003e Regarding to the part there are two opinions. Some students consider that doctor play a key role in this issue\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Of course, the role of the doctor was the most important during the covid period. But I think it was\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ea certain underestimation of nurses and brothers. Sometimes they contribute more\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003econtribution to saving a person than a doctor\u0026rdquo;\u003c/em\u003e (P2, male)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eWhile others think problem of inequity closely connected to other intuitions like ministry or department of healthcare, heads of medical organizations.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It seems to me that the role of the doctor in the inequality of the distribution of medical care was not the most significant. At that moment there was a very huge flow of infected people who needed hospitalization. It seems to me that the Ministry and health departments, not ordinary doctors, played a big role in solving this problem\u0026rdquo;\u003c/em\u003e (P4, male).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eImportant highlight that, it was hard question for many students.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It is very difficult to answer this question. If he is alone, and there are many patients, then he decides to help someone who really needs emergency care. Inequality in medicine is an acute issue. And the pandemic just revealed these gaps in medicine. One doctor will not be able to physically help everyone, despite his desire\u0026rdquo; (P8, female)\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eBecoming a member of the wider healthcare community.\u003c/strong\u003e The item is one of the interesting for participants but predominantly students answered for the questions negatively, said \u0026ldquo;No\u0026rdquo;.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003eNo. During the pandemic, I didn't consider myself a member of the wider medical community. My task at that time was to protect myself and my loved ones from the virus. I could only warn my friends and family about social responsibility, about the importance of isolation\u003c/em\u003e (P8, female).\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe participant who consider they argument own position by following statements\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;At that moment, I decided to become a volunteer in a mobile hospital. I worked there for about three months, I had to do far from the cleanest work, such as washing dead people, hygiene of patients. I also translated medical scientific articles, helped to compile protocols. I was also engaged in the sale of masks at discounted prices, almost two times lower than the market. I thought it was my duty as a citizen and a medic\u0026rdquo;\u003c/em\u003e (P1, male)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAppreciation of person-centered care was hard question for each participant.\u003c/strong\u003e Large part of students think that they could not avoid bias in this question due different circumstances such as personal point of view, cultural and others. Although they consider that we should try to be more objective and follow ethical norms.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I don't want to lie, but it seems to me that I would be more attentive to the patient who is a relative for me. I think there's nothing you can do about it, that's human nature.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eAlso, there are other opinion related to the item\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think patient orientation is very important for a healthcare professional. The main goal is not to harm the patient, but to lead him to improvement or recovery. All patients are different. Therefore, the doctor should have an individual approach to each patient\u0026rdquo;\u003c/em\u003e (P8, female)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAwareness of personal needs and self-care.\u003c/strong\u003e We can see all participant expressed the similar point of view regarding to the question\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My awareness of personal needs has improved since the pandemic. First of all, you need to take care of your health. Because without health, you can't take care of your loved ones. For example, how can a mother take care of her child if she is sick? Therefore, first of all you need to take care of yourself and monitor your health\u0026rdquo;\u003c/em\u003e (P8, female).\u003c/p\u003e\n\u003c/div\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eThis study employed a qualitative approach to explore the experiences of Nazarbayev University medical students during the COVID-19 pandemic. Four themes emerged: wellbeing, education, coping strategies, and professional identity formation.\u003c/p\u003e\n\u003cp\u003eAnxiety was widespread, and about half of students reported insomnia and emotional burnout, largely linked to stress, workload, and isolation. Loneliness was a frequent concern, consistent with Holm-Hadulla\u0026rsquo;s finding that 75% of students experienced social isolation leading to poor motivation and depression. Students described sadness, worry, disrupted routines, and fear of infection, a phenomenon also referred to as \u0026ldquo;Coronaphobia\u0026rdquo; (Kanekar \u0026amp; Sharma, 2020). These symptoms often persisted beyond the initial lockdown, as seen in other epidemics (Serafini et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). Female students reported more severe anxiety and depression, echoing findings by Bennett et al. and Villani et al. (2021), highlighting the need for gender-sensitive support.\u003c/p\u003e\n\u003cp\u003ePositive effects were also noted. Many students spent more time with family, adopted hobbies, or deepened their studies. However, depression, anxiety, sleep disturbances, and overeating still impaired academic performance (Brenner et al., 2020). Concerns about parents\u0026rsquo; health were common (Seetan et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e). Some students attributed their symptoms to disrupted routines, others to post-COVID neurological effects such as memory and concentration decline.\u003c/p\u003e\n\u003cp\u003eSocial isolation further harmed wellbeing, particularly for those living alone or in dormitories. Limited workspace, lack of direct communication with faculty, and online education reduced motivation. Most students perceived online learning as burdensome, though some appreciated its flexibility and efficiency. Key barriers included poor internet, distractions at home, and limited opportunities for discussion. Clinical practice was particularly disrupted for MD and nursing students, while first-year and public health students were less affected.\u003c/p\u003e\n\u003cp\u003eCoping strategies relied heavily on family and peer support, hobbies, exercise, and self-study. Few accessed professional psychological services due to financial or institutional barriers. This differs from studies emphasizing meditation and time management (Yusoff et al., 2021; Sahu et al., 2021). Despite challenges, students demonstrated altruism through volunteering, donations, and adherence to preventive measures.\u003c/p\u003e\n\u003cp\u003eProfessional identity was shaped by heightened social responsibility. Some volunteered in COVID-19 hospitals, others educated relatives and peers. Views diverged on doctors\u0026rsquo; role in addressing health inequities: some saw them as central, while others emphasized systemic decisions by health authorities. Students who volunteered felt part of the wider medical community, though others saw this as an overstatement of their role. Patient-centered care raised ethical dilemmas: while students valued equal treatment, many admitted they might prioritize relatives due to cultural or personal biases. All emphasized greater awareness of self-care and the need to protect one\u0026rsquo;s health to serve others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003eA key strength of this qualitative design was its ability to capture nuanced experiences beyond survey data. The inclusion of students from different disciplines and backgrounds provided diversity of perspectives. Limitations include the short study period and lack of baseline mental health data, making it difficult to attribute all outcomes solely to the pandemic.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe COVID-19 pandemic created significant challenges for medical students\u0026rsquo; mental health and wellbeing, marked by high levels of stress, anxiety, insomnia, and burnout. Female students reported greater vulnerability, underscoring the need for gender-sensitive support.\u003c/p\u003e\u003cp\u003eOur findings align with previous studies on mental health, academic disruption, and social responsibility, while also revealing unique coping strategies. Unlike international research that emphasized meditation and time management, participants in this study relied more on communication, family support, and physical activity.\u003c/p\u003e\u003cp\u003eIn addition, several novel themes emerged, including awareness of doctors\u0026rsquo; role in addressing health inequities, the sense of belonging to the wider healthcare community, person-centered care, and increased attention to self-care.\u003c/p\u003e\u003cp\u003eThese results confirm both shared and distinctive experiences of medical students in Kazakhstan, highlighting the importance of tailored interventions and the need for further qualitative research to explore long-term impacts and effective support strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was approved by the Institutional Research Ethics Committee (IREC) of Nazarbayev University School of Medicine. The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. A copy of the ethics approval is available with the corresponding author.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe author declares no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eAuthors\u0026rsquo; information (optional)\u003c/h2\u003e\u003cp\u003eNabiy Arystan is a PhD student in Global Health at Nazarbayev University School of Medicine, Kazakhstan.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNabiy Arystan conceptualized and designed the study, developed the methodology, conducted data collection, and performed the qualitative analysis. Nabiy Arystan also interpreted the findings, drafted the manuscript, and revised it critically for important intellectual content. The author is solely responsible for all aspects of the work and has approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe author would like to acknowledge Professor Faye Foster for her valuable guidance and constructive feedback during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBennett J, Heron JE, Gunnell DJ, Purdy S, Linton M-J. The impact of the COVID-19 pandemic on student mental health and wellbeing in UK university students: a multiyear crosssectional analysis. J Mental Health. 2022;31(4):597\u0026ndash;604. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09638237.2022.2091766\u003c/span\u003e\u003cspan address=\"10.1080/09638237.2022.2091766\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrenner MH, Bhugra D. Acceleration of Anxiety, Depression, and Suicide: Secondary Effects of Economic Disruption Related to COVID-19. Front Psychiatry. 2020;11:592467. doi: 10.3389/fpsyt.2020.592467. Erratum in: Front Psychiatry. 2021;12:660659. PMID: 33384627; PMCID: PMC7771384.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCacciatore M, Raggi A, Pilotto A, Cristillo V, Guastafierro E, Toppo C, Magnani FG, Sattin D, Mariniello A, Silvaggi F, Cotti Piccinelli S, Zoppi N, Bonzi G, Gipponi S, Libri I, Bezzi M, Martelletti P, Leonardi M, Padovani A. Neurological and Mental Health Symptoms Associated with Post-COVID-19 Disability in a Sample of Patients Discharged from a COVID-19 Ward: A Secondary Analysis. Int J Environ Res Public Health. 2022;19(7):4242. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19074242\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19074242\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35409924; PMCID: PMC8998950.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurran PJ, West SG, Finch JF. The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychol Methods. 2001;6(1):3\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/1082-989X.6.1.3\u003c/span\u003e\u003cspan address=\"10.1037/1082-989X.6.1.3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiener E, Lucas RE, Oishi S. Subjective well-being: The science of happiness and life satisfaction. In: Snyder CR, Lopez S, editors. Handbook of Positive Psychology. New York: Oxford University Press; 2002. pp. 63\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHalperin SJ, Henderson MN, Prenner S, Grauer JN. Prevalence of Anxiety and Depression Among Medical Students During the Covid-19 Pandemic: A Cross-Sectional Study. J Med Educ Curric Dev. 2021;8:2382120521991150. PMID: 33644399; PMCID: PMC7890732.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKonstantinov V, Berdenova S, Satkangulova G, et al. COVID-19 Impact on Kazakhstan University Student Fear, Mental Health, and Substance Use. Int J Ment Health Addict. 2022;20:888\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11469-020-00412-y\u003c/span\u003e\u003cspan address=\"10.1007/s11469-020-00412-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKeyes CLM. Mental illness and/or mental health? Investigating axioms of the complete state model of health. J Consult Clin Psychol. 2005;73(3):539\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1037/0022-006X.73.3.539\u003c/span\u003e\u003cspan address=\"10.1037/0022-006X.73.3.539\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTam MW, W. W., Ho RC. Prevalence of depression amongst medical students: A meta-analysis. Med Educ. 2016;50(4):456\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eO'Connor RC, Wetherall K, Cleare S, McClelland H, Melson AJ, Niedzwiedz CL, O'Carroll RE, O'Connor DB, Platt S, Scowcroft E, Watson B, Zortea T, Ferguson E, Robb KA. Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health \u0026amp; Wellbeing study. Br J psychiatry: J mental Sci. 2021;218(6):326\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/bjp.2020.212\u003c/span\u003e\u003cspan address=\"10.1192/bjp.2020.212\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePfefferbaum B, North CS. Mental health and the Covid-19 pandemic. N Engl J Med. 2020;383(6):510\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRomeu-Labayen M, Tort-Nasarre G, Alvarez B, Subias-Miquel M, V\u0026aacute;zquez-Segura E, Marre D, Galbany-Estragu\u0026eacute;s P. Spanish nurses' experiences with personal protective equipment and perceptions of risk of contagion from COVID-19: A qualitative rapid appraisal. J Clin Nurs. 2022;31(15\u0026ndash;16):2154\u0026ndash;66. Epub 2021 Sep 15. PMID: 34528310; PMCID: PMC8662180.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSerafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M. The psychological impact of COVID-19 on the mental health in the general population. QJM: Int J Med. 2020;113(8):531\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh S, Bhoi AK. Social responsibility of medical students in COVID-19 pandemic. J Med Educ Curric Dev. 2020;7:2382120520951814. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/2382120520951814\u003c/span\u003e\u003cspan address=\"10.1177/2382120520951814\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSauer N, Sałek A, Szlasa W, Ciecieląg T, Obara J, Gaweł S, Marciniak D et al. (2022). The Impact of COVID-19 on the Mental Well-Being of College Students. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(9), 5089. MDPI AG. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.3390/ijerph19095089\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19095089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeetan K, Al-Zubi M, Rubbai Y, Athamneh M, Khamees A, Radaideh T. Impact of COVID-19 on medical students' mental wellbeing in Jordan. PLoS ONE. 2021;16(6):e0253295. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0253295\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0253295\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 34138964; PMCID: PMC8211263.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO Coronavirus (COVID-19). Dashboard. (n.d.). With Vaccination Data. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://covid19.who.int/\u003c/span\u003e\u003cspan address=\"https://covid19.who.int/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, McIntyre RS. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord. 2020;277:55\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19 pandemic, medical students, mental health, well-being, coping strategies, Kazakhstan","lastPublishedDoi":"10.21203/rs.3.rs-7506110/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7506110/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe COVID-19 pandemic has had a profound effect on the mental health of medical students worldwide. This study aimed to explore how Nazarbayev University medical students experienced and perceived these challenges during the pandemic.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA phenomenological qualitative design was applied. Ten students (five male, five female, aged 18\u0026ndash;33) participated in semi-structured Zoom interviews between February and March 2022. Interviews were recorded, transcribed verbatim, and analyzed using Braun and Clarke\u0026rsquo;s thematic analysis framework.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFour main themes were identified: (1) impacts on wellbeing, including anxiety, depression, burnout, insomnia, and loneliness; (2) effects on education, such as disrupted routines, increased workload, and difficulties with online learning; (3) coping mechanisms, with students relying mainly on family support, hobbies, and physical activity, while formal psychological support was rarely accessed; and (4) professional identity formation, where many students expressed increased social responsibility and engagement in volunteering. Participants emphasized concerns about infection risks, academic performance, reduced clinical practice opportunities, and uncertainty about the future.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe pandemic significantly affected medical students\u0026rsquo; mental health, academic achievement, and professional development. Targeted interventions, mental health support, and improved educational strategies are needed to mitigate long-term consequences and better prepare students for future health crises.\u003c/p\u003e","manuscriptTitle":"Nazarbayev University School of Medicine Master of Public Health Program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 12:55:56","doi":"10.21203/rs.3.rs-7506110/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"109154367863168053636750171226394244748","date":"2025-10-09T19:16:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T19:00:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119782615408695933187156458539355518134","date":"2025-10-09T17:41:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T16:31:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-19T06:13:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-05T08:56:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-05T08:56:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-09-01T08:24:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75c42bb4-6d78-46e8-9a50-c5fd3199e41b","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T12:55:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 12:55:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7506110","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7506110","identity":"rs-7506110","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}