The impact of COVID-19 on health professions student’s perceptions, future education and career aspirations and confidence in public health responses

Abstract

Objective: To understand student perceptions, interest and intentions of pursuing public health as a result of COVID-19 during educational experiences. Participants: Two hundred seventy-seven students completed the survey representing 38 states and two countries. Methods: An online survey was administered to current undergraduate and graduate students at two institutions. Results: The difference between the ease of attaining a public health job for nonpublic health and public health students was significant prior to (p = .002) and during the pandemic (p = .015). There was an increase of 5.8% in student interest in continuing education in public health. 13% of respondents agreed the pandemic had been handled appropriately at the national level and 33% at the state level, and 57% expressed distrust of future responses. Conclusions: This study demonstrates a positive influence of COVID-19 on the desire to seek further education and careers in public health, highlights a lack of confidence in effective future pandemic responses.

Keywords:

• COVID-19
• curriculum
• health education
• health careers
• health professions

Introduction & background

The COVID-19 pandemic has affected the world in unprecedented ways by posing public health challenges and impacting daily lives on a global scale.¹ This pandemic has resulted in large-scale loss of life, debilitating illness, exacerbated mental health issues, caused disruptions to economies, and has changed the operating environment of workplaces and educational systems.^2–4 No facet of life has gone untouched by COVID-19, and colleges and universities have faced challenges in keeping their doors open, keeping students safe while educating them, and have had to come up with creative solutions to maintain their operating environments.

College and universities play a central role in educating our future workforce, including clinical health professionals and public health practitioners.^5,6 Training this workforce has become increasingly vital for addressing COVID-19, but has not been without challenges.^7–10 The COVID-19 pandemic has provided a unique opportunity to understand the challenges, opportunities, and perceptions of those being trained in the health professions. It offers a way to explore and to examine whether or not these students feel they have been adequately prepared to enter into a workforce responsive to a variety of needs, including a pandemic, and what could be done to work on better meeting the educational needs of health professions students in the future.

This paper presents results from a study conducted to better understand the impact of COVID-19 on students studying to become clinicians or work in the field of public health. This study provided a space to explore whether or not the pandemic has impacted these students’ interest in public health and could open up opportunities for exploring the value of incorporating broader public health training across the health professions. This pandemic offered an opportunity to better understand what motivates students to go into various health professions, and if their perceptions, interest and intentions shifted as a result of exposure to a major event, such as a pandemic during their educational experience. Lastly, this study provided an opportunity to understand the perceptions of future healthcare providers in terms of their confidence in the response efforts that had been implemented at that point in time. While there are other studies that have examined confidence in the government to respond to various crises, we were particularly interested in understand health professions students’ perceptions given they would be entering the workforce soon and could play a role in future responses as well as the perceptions of confidence in the ability of the healthcare system to react.

Methodology

Participants

This study examined the perceptions, knowledge, and possible influence on future careers that the COVID-19 pandemic had on current health professions students at the undergraduate and graduate level at Shenandoah University and Grand Canyon University.

Shenandoah University was founded in 1875 and is a private liberal arts institution with its main campus located in Winchester, VA. Shenandoah University has an enrollment of more than 3,700 students, half of which are at the graduate level. Shenandoah University offers 41 undergraduate degrees and 24 graduate degrees, with multiple health profession degrees available. Grand Canyon University was chartered in 1949 and is a private Christian university located in [location omitted for anonymity]. Grand Canyon University’s total enrollment is over 90,000 students, with 20,000 traditional on-campus students, and 70,000 online students. Grand Canyon University offers over 200 programs in 9 distinct colleges. The College of Nursing and Healthcare professions offers clinical and non-clinical degrees. During the pandemic, both Shenandoah University and Grand Canyon University instituted various measures to reduce the spread of COVID, such as masking, social distancing and at times moving to fully online education across programs. Prior to the pandemic Shenandoah University, had only one fully online program and two hybrid programs, while Grand Canyon University previously had several fully online programs, while also having a significant in-person presence.

Procedures and timeline of survey

An online questionnaire was created in Qualtrics and distributed via email and the online learning platform announcements to undergraduate and graduate health professions students at Shenandoah University and to graduate health professions students at Grand Canyon University. Data were collected at Grand Canyon University from November 23 to December 12, 2020 and at Shenandoah University from February 1 to 15, 2021. Prior to taking the survey, students were informed on the purpose of the study and the anonymity and confidentiality of their responses. Permission to conduct this study was obtained from the Institutional Review Boards (IRB) at Shenandoah University and Grand Canyon University.

Research instrument

In this study, a 14-question survey was used to assess a variety of study questions about the student’s experiences and perceptions related to the COVID-19 pandemic. The survey questions sought to answer the following research questions:

1. Has the COVID-19 pandemic influenced more health profession’s students to continue their education in public health and/or influenced their future career interests in public health?

2. Has the COVID-19 pandemic influenced health professions student’s interest in learning more about public health?

3. Has the COVID-19 pandemic influenced health professions student’s current knowledge about public health?

4. Do health profession’s students believe that the COVID-19 response has been handled appropriately locally and nationally?

Data on demographic and personal characteristics were collected, including sex, program type, degree program, year in program, age, state of residence and race. The survey instrument asked questions about 1) interest in public health prior to and during the COVID-19 pandemic; 2) knowledge of public health during the COVID-19 pandemic; 3) perception of the public health job market prior to the COVID-19 pandemic, during the COVID-19 pandemic, and in 1–2 years; 4) likelihood to consider educational pursuits in public health prior to and during the COVID-19 pandemic; 5) likelihood to pursue a job in public health prior to and during the COVID-19 pandemic; and 6) perception of the pandemic response at the national, state and local level. The specific survey questions are included in the results Tables with associated response options included (see Tables 2–6).

Table 2. Public health knowledge.

Question: Knowledge of Public Health Has increased during pandemic	N	%	p-value
Institution
SU
Agree	101	78
Disagree	28	28
GCU
Agree	137	58
Disagree	101	42
			0.001
Degree type
Public Health
Agree	78	94
Disagree	5	6
Nonpublic Health
Agree	160	83
Disagree	34	34
			0.012

Table 6. Pandemic response perception and future trust.

Question	Feel the pandemic was handled appropriately at national level	Feel the pandemic was handled appropriately by my state	Trust the U.S. to respond to future pandemics appropriately	Trust local health officials respond to future pandemics appropriately
Institution
SU
Agree	12	46	23	52
Disagree	117	83	106	77
GCU
Agree	24	48	43	67
Disagree	124	100	105	81
p-value	p = .088	p = .572	p = .029	p = .405
Degree type
Public Health
Agree	14	34	31	48
Don’t Know	5	5	27	17
Disagree	64	44	25	18
Nonpublic Health
Agree	22	60	35	71
Don’t Know	22	32	67	72
Disagree	150	102	92	51
p-value	p = .210	p = .106	p = .001	p = .001

The survey employed a 3-point Likert scale. Depending the survey question (see Tables 2–6), answer options included: Interested [1], Don’t know [2], Not Interested [3]; Agree [1], Don’t know [2], Disagree [3]; or Easy [2], Don’t know [2], Not easy [3]; and 4) Likely [1], Unsure [2], Unlikely [3].

Table 3. Interest in learning about public health.

Question	How Interested in Learning about Public Health Prior to the Pandemic N (%)	How Interested in Learning about Public Health During Pandemic N (%)
Institution
SU
Interested	85 (66)	105 (81)
Not interested	44 (34)	24 (19)
GCU
Interested	121(82)	138 (93)
Not interested	27 (18)	10 (7)
p-value	.003	.003
Degree type
Public Health
Interested	78 (94)	81 (98)
Not interested	5 (6)	2 (2)
Nonpublic Health
Interested	128 (66)	162 (84)
Not interested	66 (34)	32 (16)
p-value	<.001	.001

Table 4. Public health job market.

Question	Prior to pandemic how easy was it to get a public health job	During pandemic how easy was it to get a public health job?	How easy do you think it will be 1–2 years from now to get a public health job?
Institution
SU
Easy	31	37	45
Not Easy	97	92	84
GCU
Easy	27	76	82
Not Easy	121	72	62
p-value	p = .224	p < .001	p = .001
Degree type
Public Health Easy	8	43	51
Don’t Know Not Easy	44 31	24 16	24 8
Nonpublic Health
Easy	50	70	76
Don’t Know	105	83	99
Not Easy	38	41	19
p-value	p = .002	p = .015	p = .001

Table 5. Future education and career interests.

Question	Prior to pandemic how likely to continue education in public health?	During pandemic how likely to continue education in public health?	Prior to the pandemic how likely to seek a job in public health post-graduation?	During the pandemic how likely to seek a job in public health post-graduation?
Institution
SU
Likely	60	62	51	58
Unlikely	68	67	77	71
GCU
Likely	104	118	97	111
Unlikely	44	29	51	37
p-value	p < .001	p < .001	p < .001	p < .001
Degree type
Public Health
Likely	68	79	63	79
Unsure	12	3	15	4
Unlikely	2	1	5	0
Nonpublic Health
Likely	96	101	85	90
Unsure	43	47	47	42
Unlikely	56	46	62	62
p-value	p < .001	p < .001	p < .001	p < .001

Data analysis

SPSS version 25 was used to conduct the analysis. The data were analyzed as categorical variables. For the purpose of the analysis, response options were categorized into 2 groups: 1) Interested vs. Don’t know/Not Interested; 2) Agree vs. Don’t know/Disagree; 3) Easy vs. Don’t know/Not Easy and 4) Likely vs. Unsure/Unlikely. The question regarding degree programs was re-coded into a dichotomous variable: public health vs. nonpublic health. Chi-squared tests were used to compare participants’ degree program and institution with interest in learning about the COVID-19 pandemic, knowledge of public health, perception of the public health job market, likelihood to consider education pursuits in public health, likelihood to pursue a public health job, and perception of the pandemic response. P < 0.05 was considered statistically significant.

Ethical clearance

Permission to conduct this study was obtained from the IRB at Shenandoah University and Grand Canyon University.

Results

Demographics

A total of 277 students completed the survey with 53.4% of students were from Grand Canyon University, and 46.6% of students from Shenandoah University. Of the study population, 90.3% identified as female, and 9.7% identified as male. In terms of degree level, 84.5% percent identified as graduate students, compared to 14.4% as undergraduate students and then 1.1% identified as graduate certificate students. The top three-degree programs represented included public health (30.0%), physical therapy (15.5%), and occupational therapy (15.2%) and 70.0% of students were enrolled in a nonpublic health degree and 30% in a public health degree program. In terms of years in their program, 49.8% of students stated they were in year 1 of their program, compared to 34.3%, 13.0%, 1.4%, and 1.1% in years 2, 3, 4, and 5 or greater, respectively. The age of students ranged from 18 to over 61, with 33.2% percent of students between the ages of 22 and 25 years. Students represented 38 states and 2 countries with Virginia (35.0%), Arizona (22.4%), and California (8.3%) as the top 3 represented states. In terms of race, 65.0% percent of students identified as White, compared to 12.3% Hispanic or Latinx, 11.2% Black or African American, 4.3% Asian, 4.0% Multi-racial, 2.2% other, and 1.1% Native Hawaiian and Pacific Islander. A summary of key demographics described here can be found in Table 1.

Table 1. Study demographics.

Demographic categories	Frequency	Percentage
School attending
Shenandoah University	129	47
Grand Canyon University	148	53
Sex
Male	27	10
Female	250	90
Age
18–21	44	16
22–25	92	33
26–30	54	20
31–35	29	11
36–40	23	8
41–45	16	6
46–50	12	4
51–55	3	1
56–60	3	1
61+	1	<1
Race
Asian	12	5
African or African American	31	11
Hispanic or Latinx	34	12
Multi-racial	11	4
Native Hawaiian and Pacific Islander	3	1
White	180	65
Other	6	2
Degree program
Public Health	83	30
Nonpublic Health	194	70
Year in program
Year 1	138	50
Year 2	95	34
Year 3	36	13
Year 4	4	2
Greater than 5	3	1
Region reside in
West	116	42
Mid-West	6	<1
East	19	7
South	135	49
Outside US	1	<1

Current public health knowledge

In terms of self-perceived public health knowledge, 85.9% of students agreed with the statement “my knowledge of public health has increased during the COVID-19 pandemic”. 92.6% of Grand Canyon University students agreed with the statement, compared to 78.3% of Shenandoah University students (p = .001). When stratified by nonpublic health vs. public health, 82.5% and 94.0% agreed with the statement, respectively. Results of chi-square tests show a significant difference between public health and nonpublic health students (p = .012). See Table 2 for details.

Interest in learning about public health

Overall, 74.4% of students stated they were interested in learning about public health prior to the COVID-19 pandemic, compared to 87.7% during the COVID-19 pandemic. Grand Canyon University student interest increased from 81.8% to 93.2%, whereas Shenandoah University student interest increased from 65.9% to 81.4%. The difference in interest between Grand Canyon University and Shenandoah University is statistically significant both prior to (p = .003) and during the pandemic (p = .003). When stratified by degree type, nonpublic health student’s interest increased from 66.0% to 83.5% (p < .001), compared to public health students which increased from 94.0% to 97.6%. Results of chi-square tests show a significant difference in interest between nonpublic health and public health students both prior to (p < .001) and during the pandemic (p = .001). See Table 3 for details.

Perceptions of public health job market

In terms of perceived public health job availability, 20.9% of students responded “Easy” in response to the question “prior to the COVID-19 pandemic, how easy do you think it was to get a job in public health.” In terms of perceived ease in attaining a public health job, 40.8% responded “Easy” in response to “now, during the COVID-19 pandemic, how easy do you think it is to get a job in public health.” When asked “how easy do you think it will be to get a job in public health 1-2 years from now,” 45.8% selected “Easy.”

When comparing Grand Canyon University to Shenandoah University, 18.2% and 24.0% stated it would be easy to find a job in public health prior to the pandemic, 51.4% and 28.7% during the pandemic, and 55.4% vs. 34.9% in 1–2 years from now. The difference in the perception of the public health job market between institutions is statistically significant for the questions referencing during the pandemic (p < .001) and 1–2 years from now (p = .001). There was no statistically significant difference by institution regarding ease of finding a job in public health prior to the pandemic (p = .224).

When stratified by nonpublic health and public health degree type, 25.8% percent of nonpublic health students thought it was easy to get a job in public health prior to the pandemic, 36.1% during the pandemic, and 39.2% perceived it would be easy in 1–2 years; compared to 9.6%, 51.8%, and 61.4% public health students, respectively. The difference between the perception of the public health job market for nonpublic health and public health students is significant at all three time points: prior to the pandemic (p = .002), during the pandemic (p = .015), and 1–2 years from now (p = .001). See Table 4 for details.

Future educational or career interests

Overall, 59.2% of students stated they were likely to continue their educational pursuits in public health prior to the COVID-19 pandemic, compared to 65.0% during the COVID-19 pandemic. Grand Canyon University student likelihood increased from 70.3% to 79.7%, compared to Shenandoah University which increased from 46.5% to 48.1%. The difference in likelihood by institution was significant both prior to (p < .001) and during the pandemic (p < .001). When stratified by degree type, nonpublic health student’s likelihood increased from 49.5% to 52.1%, compared to public health students which increased from 81.9% to 95.2%. Results of chi-square tests show a significant difference in likelihood between nonpublic health and public health students both prior to (p < .001) and during the pandemic (p < .001).

In regard to likelihood of seeking a job in public health post-graduation, 53.4% of all students stated they were likely to seek a job in public health prior to the pandemic, compared to 61.0% during the pandemic. Likelihood for Grand Canyon University students increased from 65.5% to 75.0%, compared to Shenandoah University students which increased from 39.8% to 45.0%. The difference between Grand Canyon University and Shenandoah University student likelihood was significant for both prior to the pandemic (p < .001) and during the pandemic (p < .001). For nonpublic health students, likelihood increased from 43.8% to 46.4%, compared to public health students, where it increased from 75.9% to 95.2%. There was a significant difference in likelihood between nonpublic health and public health students prior to the pandemic (p < .001) and during the pandemic (p < .001). See Table 5 for details.

Pandemic response perception and future trust

Overall, 13.0% percent of participants agreed the pandemic response has been handled appropriately at the national level. When comparing Grand Canyon University vs. Shenandoah University students, 16.2% of Grand Canyon University students agreed, compared to 9.3% of SU students (p = .088). When comparing nonpublic health to public health students, the percent who “Agreed” was 11.3% and 16.9%, respectively. The difference between nonpublic health and public health students was not statistically significant (p = .210).

In response to the question “I trust the U.S. to respond to future pandemics appropriately,” 23.8% of participants agreed with the statement. Grand Canyon University students were more likely to agree than Shenandoah University students, at 29.1% and 17.8% respectively. This difference was statistically significant (p = .029). Public health students were more likely to agree with the statement compared to nonpublic health students, at 37.3% and 18.0% respectively. Results of chi-square tests show this difference was statistically significant (p = .001)

In response to the prompt, “The pandemic response has been handled appropriately by my state,” 33.9% of participants agreed with the statement. When stratified by institution, 32.4% of Grand Canyon University students agreed, compared to 35.7% of Shenandoah University students (p = .572). When split by degree type, 30.9% of nonpublic health students agreed with the statement, compared to 41.0% of public health students. This difference was not statistically significant (p = .106).

In response to the prompt, “I trust my local health officials to respond to future pandemics appropriately” overall 43.0% of participants agreed with the statement. 29.1% of Grand Canyon University students agreed, compared to 17.8% of Shenandoah University students (p = .405). 36.6% of nonpublic health students agreed, compared to 57.8% of public health students. This difference was statistically significant (p = .001). See Table 6 for details.

Discussion

From the results of this study, both Shenandoah University and Grand Canyon University student populations reported a general increase in their knowledge of public health, and in particular for nonpublic health students. Overall interest in learning more about public health increased as a result of the pandemic at both intuitions, with a greater difference observed at Shenandoah University vs Grand Canyon University and a greater interest observed in nonpublic health versus public health majors at both institutions. Based on this information, it could be beneficial for programs to consider placing an increased emphasis on training students in the clinical professions on basic public health prevention and intervention methods, and the student interest and appetite to know more about public health supports this. Additionally, increasing knowledge about public health principles may have the potential to translate into better equipping future clinicians with public health skill to enhance their ability to respond effectively to any future public health crises that may arise.

Perceptions of the job market for participants changed prior to and during the pandemic. Students perceived the ease of attaining public health jobs to increase quite a bit prior to as opposed to during the pandemic. The same students perceived that the ease of getting a job 1–2 years from now would increase, but not as much as during the pandemic. Students at Shenandoah University reported greater sense of ease in getting a public health job during the pandemic compared to Grand Canyon University students. At both institutions, public health students perceived the ease of getting a job during the pandemic and 1–2 years from now to be easier than nonpublic health students.

Participants at both institutions indicated an interest in continuing their education in public health in both the nonpublic health and public majors. Students at both intuitions also reported they were more likely to pursue a public health degree during the pandemic then prior to the pandemic. The likelihood increased for both public health and nonpublic health majors, but with a slightly more interests among public health students. Based on this information, many students expect the job market to be more responsive of public health graduates and a need for greater public health training in the future. A more robust and responsive job force for students trained in public health, may or may not be the reality and remains to be seen as we move forward.

Only a small percentage of participants agreed that the pandemic response had been handled appropriately at the national level. While there was greater confidence among participants that the US would handle future pandemics appropriately, less than 25% of the entire sample felt this way, and public health students were more likely to have greater confidence compared to their nonpublic health peers. There was greater confidence among participants that states and local entities had handled, and would handle future pandemic appropriately. This signifies a need to build the confidence of national and local responses to pandemics, not just among the general public, as has already been shown to be divided nation-wide, but amongst the future healthcare workforce. Training a workforce that is trusting of national and local responses will be vital when facing another public health crisis.

Study limitations

Despite the information gleaned from this study, there are limitations to the study results. This study targeted students at institutions that are different in type, size, geographic location, and student body demographics; therefore, the results may not be generalizable to all institutions training students in the health professions. The survey was created by the researchers based on the limited available literature on COVID-19 at the time, and therefore has not been tested for validity and reliability measures, which limit the conclusions that can be drawn here. It is also possible that participants may have responded more positively or negatively about a particular question due to the timing of where student was in their educational experience, timing of where the pandemic was globally when questions were asked, and timing of when the survey was administered at each institution. The conclusions drawn from this study are based on student perceptions at only one time period and not based on following participants over time to see if their experiences and perceptions change over time, or as they transition into careers and the work environment.

Despite these limitations, valuable conclusions were drawn about student knowledge, perceptions, and confidence as it relates to the COVID-19 pandemic. To our knowledge, this study marks one of the only studies that has attempted to understand the impact of COVID-19 on student’s exposure to public health and influence on seeking additional education or careers in the field of public health. It has also highlighted the role that creative curricular approaches can play in influencing a more robust health professions workforce that have a foundation of public health training, particularly for the clinical professions.

Conclusion

While the COVID-19 pandemic has posed many challenges, these results demonstrate that there has been a positive influence on the desire of students in this study to learn more and seek further education and careers in the field of public health. It highlights the positivity felt among current public health and nonpublic health students about the job market for those trained in public health even during a period of economic uncertainty. This study also brings to the forefront the overall lack of confidence these students have in their states, and in particular the nation’s ability to adequately respond to future pandemics effectively. While mistrust or lack of confidence in the government’s response is not new information and has been previously documented,^11–13 this study further highlights the need to address this, if possible, as part of the educational experience. Students represent the future of the healthcare workforce, and this lack of confidence represents a hurdle the entire healthcare field will have to contend with.

This study also highlights the opportunity, in particular for the field of public health, to expand curricular reach into other health professions. Specifically, the pandemic has highlighted a need for clinical professions to have an understanding of public health approaches, prevention efforts and interventions in order to effectively treat populations. While many clinical programs do offer or require their students to take a course in public health, the pandemic has provided insight into the need for focused training that equips a broad suite of health professionals for the next pandemic or global health crisis. The pandemic has, and continue, to provide, opportunities for a multisectoral approach to training health professionals across many fields to lead to well-rounded professionals entering the field of healthcare.

Conflict of interest disclosure

The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adhering to the legal requirements of the United States and received approval from Shenandoah University and Grand Canyon University.

Funding

No funding was used to support the research and/or the preparation of the manuscript.