Psychological Impact of Academic Disruption on Medical Students: A Systematic Review

Article information

Korean Med Educ Rev. 2025;27(Suppl 1):S3-S17

Publication date (electronic) : 2025 December 31

doi : https://doi.org/10.17496/kmer.25.024

Ho Young Cho¹, So Jung Yune^,2

¹Pusan National University School of Medicine, Yangsan, Korea

²Department of Medical Education, Pusan National University School of Medicine, Busan, Korea

Corresponding author: So Jung Yune Department of Medical Education, Pusan National University School of Medicine, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-51-510-8025 Fax: +82-55-382-8124 E-mail: cc139@pusan.ac.kr

*This article was selected as the Grand Prize winner in the 1st Korean Medical Education Review Student Researcher Award competition and was published following peer review.

Received 2025 August 15; Revised 2025 November 25; Accepted 2025 December 4.

Trans Abstract

Introduction

Prolonged interruptions in medical education pose a critical yet understudied threat to medical students’ psychological well-being and professional development. Although global disruptions—from the coronavirus disease 2019 (COVID-19) pandemic to geopolitical conflicts—have produced consistent patterns of distress, systematic evidence remains fragmented. This gap is particularly concerning for South Korea, which is currently experiencing an unprecedented 17-month curriculum suspension due to a physician–government dispute affecting over 95% of medical students, according to Shin and Shin [1]. International studies have reported severe consequences, including a 28% anxiety rate and 48% depression rate among students who lost clinical experience according to Lin et al. [2]. Choi et al. [3] found that 77% of electives and 43% of assistantships were canceled, reducing students’ sense of preparedness, while Wearn et al. [4] reported that losing authentic bedside learning weakened professional identity formation. Despite these findings, no systematic review has synthesized psychological impacts across diverse disruption contexts to inform crisis management for Korea’s unique situation.

The application of international evidence to the Korean context is theoretically grounded in several key principles. As Cruess et al. [5] note, medical education follows universally recognized competency-based progression models, making Korean medical students susceptible to the same disruption mechanisms identified internationally. The Korean medical education system shares core structural features with global models, including sequential curriculum progression, high-stakes assessments, intensive clinical training, and strong expectations for professional identity formation.

Medical students’ learning has been disrupted by varied events, including the COVID-19 pandemic, natural disasters, and armed conflicts. However, previous studies have used differing terminologies and conceptual frameworks within their respective contexts, limiting comprehensive understanding of how academic disruption affects psychological well-being. Disaster-related studies, for example, examined changes in academic performance following physical disruptions to learning environments according to Wilkinson et al. [6], whereas COVID-19 research has focused on the effects of rapid transitions to remote learning according to Motte-Signoret et al. [7] and Shahrvini et al. [8]. Although these studies provide valuable insights within their specific contexts, the diversity of research designs and measurement tools has constrained the development of consistent evidence on psychological impacts. Accordingly, this study aimed to systematically review research across diverse forms of academic disruption and apply a standardized psychological health framework to identify common patterns in medical students’ experiences.

For this review, academic disruption is operationally defined as any unplanned event that prevents undergraduate medical students from progressing through their intended curriculum according to the original timeline and delivery format, regardless of cause. This definition is supported by literature documenting the detrimental effects of sudden virtualization and loss of authentic clinical experience on competence development [7,8]. As Cheong [9] notes, medical students already demonstrate substantial baseline academic stress, making them particularly vulnerable to emotional distress, motivational decline, and instability in professional identity during disruptions.

To systematically categorize psychological outcomes, this review adopts the Patient-Reported Outcomes Measurement Information System (PROMIS) as the primary theoretical framework. PROMIS was selected due to its international standardization across 24 countries, as described by Cella et al. [10], its capacity for multidimensional assessment according to Hays et al. [11], its evidence-based domain structure noted by Reeve et al. [12], and its flexibility for adaptation as shown by DeWalt et al. [13]. For medical education contexts, we implemented a modified PROMIS framework comprising five core domains: (1) affect, including anxiety, depression, and anger; (2) meaning and purpose; (3) psychosocial illness impact (negative); (4) psychosocial illness impact (positive); and (5) helpful outcomes, reflecting general life satisfaction and positive affect. This consolidation reorganized PROMIS’s broader structure to better align with psychological patterns observed in academic disruption contexts. The review therefore serves two purposes: synthesizing international evidence on academic disruption effects and establishing theoretical foundations for addressing Korea’s unprecedented medical education crisis.

This systematic review addresses the following primary research question: “What is the prevalence and severity of psychological impacts across the five modified PROMIS domains among medical students experiencing academic disruption, and how does relative vulnerability differ between domains?”

Methods

1. Study design and review questions

We conducted a systematic review to summarize evidence on the psychological effects of academic disruption—including rapid transitions to remote instruction, reduced clinical practice, pandemics, natural disasters, and war—among medical students. The review question was structured using the Population-Exposure-Outcome format, following the protocol of Butler et al. [14]. The population was medical students; the exposure was academic disruptions, including study interruption, reductions in clinical training, or transitions to remote learning due to natural disasters, war, or epidemics; and the outcomes were psychological impacts resulting from academic disruption. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines by Moher et al. [15], and the study selection process is shown in Figure 1.

Figure 1.

PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow diagram for systematic review with included database searches.

3. Study selection and data extraction

A total of 1,884 records were identified. After removing duplicates and screening titles and abstracts, 33 studies were included for final synthesis. Two independent reviewers screened all studies and resolved disagreements through consensus. Data extraction included publication details, sample characteristics, disruption type and duration, psychological outcomes, and measurement tools. Psychological outcomes were categorized using the PROMIS Domain Framework adapted for academic disruption contexts. The complete study selection workflow is outlined in Figure 1, and criteria for including or excluding studies are summarized in Table 1.

Table 1.

Criteria for study inclusion and exclusion

5. Outcome definitions and domain classification

Psychological outcomes were categorized according to a modified PROMIS Domain Framework, detailed in Table 2. PROMIS was selected for three reasons: (1) it allows internationally standardized assessment across diverse populations; (2) it provides a comprehensive multidimensional evaluation of physical, mental, and social health; and (3) its flexibility supports integration of quantitative and qualitative evidence [10-13]. For this medical education context, the framework was adapted to five core domains: (1) affect (anxiety, depression, anger); (2) meaning and purpose; (3) psychosocial illness impact (negative); (4) psychosocial illness impact (positive); and (5) helpful outcomes (general life satisfaction and positive affect). The modification involved three principal changes to the original PROMIS structure: first, anxiety, depression, and anger—typically separate PROMIS domains—were consolidated under affect to reflect their shared emotional-distress nature in disruption settings; second, positive affect and general life satisfaction were combined under helpful outcomes to capture resilience; and third, psychosocial illness impact was subdivided into “negative” and “positive” to distinguish distress from post-traumatic growth, a distinction particularly relevant in academic disruption research. To prevent double-counting, outcomes coded as anxiety, depression, anger, or meaning and purpose were not redundantly coded under psychosocial illness impact.

Table 2.

Modified PROMIS domain framework adapted for the context of academic disruption

Results

The key characteristics of the 33 included studies are summarized in Table 3 [3,4,6,17-46]. Studies were conducted across 24 countries, with most (85%) examining academic disruptions during the COVID-19 pandemic, while others focused on natural disasters (n=3), war or conflict (n=2), and compound crises (n=2). Table 3 presents detailed information on each study, including country, research design, sample characteristics (size, gender, academic year), type of disruption, and psychological outcomes measured across PROMIS domains. Most studies used cross-sectional survey designs (n=24; 72.7%), followed by qualitative studies (n=7; 21.2%) and mixed-methods approaches (n=2; 6.1%). Sample sizes ranged from 13 to 3,348 participants (median=297). Academic levels represented included preclinical years 1–3 and clinical years 4–6, with some studies also including preparatory or internship cohorts. As shown in Table 3, evidence distribution varied across PROMIS domains: anxiety and depression had the strongest empirical support (22 and 21 studies, respectively), whereas anger was evaluated in relatively few studies (n=5).

Table 3.

Summary of studies included in the review (n=33)

Discussion

This systematic review addressed the research question concerning the prevalence and severity of psychological impacts across the five modified PROMIS domains among medical students experiencing academic disruption, as well as differential vulnerability across domains. Analysis of 33 studies from 24 countries revealed consistently elevated psychological distress, including anxiety (23%–84%), depression (10%–65%), and social isolation (47%–72%). These findings support the applicability of the modified PROMIS framework for categorizing psychological impacts in medical education, indicating that academic disruption influences multiple interconnected psychological domains rather than producing transient stress responses. The framework further demonstrated differential domain vulnerability, with the affect domain showing the strongest empirical evidence, whereas anger and meaning/purpose domains had limited quantitative support. Psychosocial isolation emerged as a central mechanism linking academic disruption to affective symptoms.

Widespread anxiety prevalence (23%–84%) can be interpreted as an emotional response that extends beyond routine academic stress and reflects structural vulnerabilities inherent in medical education. Early-year cohorts and female students consistently showed greater susceptibility, aligning with Spielberger’s state–trait anxiety theory, which posits that external threats interact with individual predispositions to amplify anxiety [47]. Theory predictions corresponded closely with observed patterns (early-year: 8/8 studies; female: 12/12 studies), though the predominance of cross-sectional designs (72.7%) limits the ability to distinguish temporary state elevations from more enduring trait-related patterns. While prior reviews identified similar associations [48], anxiety levels in this review appeared markedly higher, likely reflecting the unprecedented duration of educational disruption. Faculty support, peer networks, and structured routines emerged as protective factors, consistent with stress-coping frameworks [49,50]. These findings underscore the need for institutions to implement a stratified mental health approach: universal prevention through mandatory biannual GAD-7 screening with automated referral pathways for early identification [51,52]; targeted interventions for high-risk groups involving designated coordinators and anonymous digital platforms that reduce stigma-related barriers; and enhancement of protective factors by maintaining faculty–student advisor ratios not exceeding 1:10 and ensuring annual faculty training on mental health recognition [53,54]. Such tiered strategies address both population-level vulnerability and individual risk factors delineated in psychological theory.

Depression patterns (10%–65% meeting screening criteria) appear to reflect the longer-term emotional consequences of academic disruption, with extreme prevalence observed in compound crises (e.g., 87% during the Ukraine war). These results align with the cognitive theory of depression by Beck [55], wherein the hopelessness triad becomes heightened in severe contexts, although the rapid escalation seen in some settings challenges the theory’s typical gradual onset predictions. From a learned helplessness perspective, students confronted with uncontrollable circumstances may come to believe that their efforts cannot influence outcomes, though longitudinal designs are required to establish causal pathways [56]. Cross-sectional findings indicated symptom manifestations that extended beyond emotional responses to include cognitive decline and social withdrawal [57]. The wide prevalence range suggests that both disruption severity and institutional response substantially modulate depressive outcomes, supporting a dual-track prevention model. For acute disruptions, mandatory PHQ-9 screening at onset and regular intervals may allow early detection, enabling a three-tier response from peer-based support to psychiatric referral [51,52]. For long-term resilience, structured programs—such as resilience training focused on stress management and uncertainty tolerance, reflective portfolio assignments linked to professional identity, simulation-based crisis training, and peer mentorship pairing senior and junior students—can target cognitive vulnerabilities described in Beck’s model [58,59]. Transparent communication regarding timelines and progression requirements may mitigate perceived uncontrollability, a central mechanism in learned helplessness.

Evidence for anger and frustration, though limited, appears tied to unpredictable shifts in educational policy and process. Available findings were constrained to qualitative evidence from four studies and lacked validated quantitative measures, which restricts conclusions regarding the prominence of anger within the PROMIS framework. The studies that were available described frustration arising when educational structures became unstable, reflecting the frustration–aggression hypothesis within competitive learning environments [60]. Anger manifested primarily as internalized frustration and helplessness rather than outward aggression and was associated with academic avoidance and cynicism. However, the absence of standardized anger-specific tools and the small number of studies preclude definitive interpretation [61-64]. Future research should therefore incorporate validated measures of anger [64]. Existing qualitative findings nonetheless suggest that institutions may reduce frustration by addressing structural unpredictability—for example, through regular liaison meetings that include student representation in crisis-related decisions and digital platforms enabling anonymous feedback. These approaches enhance perceived control and procedural justice, directly targeting the unpredictability identified as the primary trigger for anger in qualitative studies.

The meaning and purpose domain showed divergent patterns reflecting both vulnerability and potential for growth. Early-stage students experienced disrupted identity formation, consistent with the psychosocial developmental crisis of identity versus role confusion [4,17,21]. Cross-sectional evidence suggested that early deficits in experiential learning may hinder professional identity development, though longitudinal research is required to verify long-term effects [65]. In contrast, several studies documented renewed purpose and post-crisis growth, such as post-traumatic growth observed after the 2011 Great East Japan Earthquake, where students demonstrated strengthened life motivation and professional identity [41]. These findings align with the theory by Tedeschi and Calhoun [66] that crises can prompt meaning reconstruction, with the observed biphasic pattern—initial loss followed by reconstruction—corresponding closely to theoretical predictions. From a logotherapy perspective, educational disruption may become a catalyst for growth when meaning is actively constructed [67]. These contrasting trajectories indicate that professional identity requires intentional support during disruptions. Structured clinical shadowing, including virtual patient interactions, may preserve identity continuity, as recommended in professional identity formation theory [68]. Narrative medicine workshops, competency milestone tracking, alumni mentorship networks, and reflective portfolio assignments can provide layered scaffolding to prevent identity deterioration and facilitate meaning-making processes that underpin post-traumatic growth [66,69]. Framing disruptions as potential opportunities for reflection and development aligns with the logotherapeutic emphasis on purposeful meaning construction.

Psychosocial impact findings (47%–72% reporting isolation) reflect what can be characterized as a social network crisis functioning as a central mediating mechanism. When teaching moved online or campuses closed, students reported isolation, alienation, and diminished support, directly corresponding to frustrated relatedness needs described in self-determination theory [70]. In medical education, peer relationships and faculty–student connections are integral to professional development. Following placement cancellations, 70% of students felt less prepared, suggesting that lack of performance experiences may be associated with declining self-efficacy [3,71]. This dual burden—emotional isolation combined with concerns regarding competence—creates compounding vulnerability. However, seven studies demonstrated elevated post-traumatic growth scores and strengthened motivation to help others, aligning with resilience theory’s depiction of adaptive functioning [72], with social support, flexible operations, and peer networks emerging as major protective factors. The centrality of social networks in both vulnerability and resilience suggests that multi-layered support systems informed by social capital theory are essential [53,54]. Structured peer support circles with trained facilitators, regular virtual check-ins during disruptions, preservation of small-group learning formats even online, and ensuring faculty–student advisor accessibility through scheduled liaison meetings can maintain the connectedness that self-determination theory identifies as a fundamental psychological need. Technology-enabled approaches—discussion forums, virtual study groups, and collaborative platforms—can partially compensate for lost physical proximity while institutions monitor social connectedness indicators for early detection of emerging isolation patterns.

Positive outcomes demonstrated patterns of resilience, self-direction, and preserved life satisfaction despite the negative effects of disruption. General life satisfaction measured by BMLSS remained stable across pandemic periods with no significant change [39]. According to the happiness determinant model by Lyubomirsky [73]—where genetic set-point accounts for 50%, life circumstances 10%, and intentional activities 40%—learning deficits may be buffered through intentional coping strategies. Studies reported that 6% of students experienced improvements in well-being, particularly through enhanced family relationships, exercise, or sleep [19]. The broaden-and-build theory by Fredrickson [74] suggests that such positive experiences expand psychological resources and foster long-term resilience. Studies from disaster settings further demonstrated that post-traumatic growth, including increased gratitude for life, can be quantitatively measured [34,75], challenging deficit-focused narratives. These findings indicate that resilience-building curricula should cultivate the intentional activities Lyubomirsky [73] identifies as modifiable determinants: wellness programs emphasizing physical activity, sleep hygiene, and work–life balance; reflective practices that help students articulate strengths; and recognizing positive adaptations [58]. Normalizing adaptive coping discussions reduces stigma, while peer mentorship facilitates transmission of successful coping strategies. For students exhibiting positive adaptation, articulating skills gained (e.g., self-directed learning, technological competence, flexibility) can convert disruption into recognized professional development, aligning with broaden-and-build mechanisms to consolidate crisis-induced gains into durable psychological resources.

This review has important methodological limitations. The predominance of cross-sectional study designs and the lack of baseline mental health data limit causal inference and restrict the ability to differentiate new-onset symptoms from exacerbations of pre-existing conditions. The concentration of COVID-19 studies and predominance of Western samples limit generalizability to other contexts, particularly Korea’s physician–government conflict, which represents a novel crisis combining educational disruption with institutional conflict. East Asian cultural factors—including hierarchical education structures, collectivist values, and mental health stigma—may modify the manifestation of psychological distress in ways not captured by Western-derived evidence. The PROMIS framework was further constrained by limited quantitative data in certain domains, especially anger, and measurement heterogeneity precluded meta-analysis. Future research should prioritize prospective longitudinal studies among Korean medical students, qualitative investigations into culturally specific experiences, head-to-head comparisons across crisis types, and intervention trials assessing culturally adapted strategies.

Conclusion

This systematic review indicates that academic disruption is consistently associated with substantial increases in anxiety, depression, and social isolation among medical students, with qualitative evidence highlighting professional identity challenges as key underlying mechanisms. Medical education policymakers must therefore establish comprehensive crisis response systems that protect psychological well-being while ensuring continuity of training. However, generalizability to Korea’s unprecedented physician–government conflict requires caution due to the predominance of Western samples and potential cultural differences in distress expression. Context-specific research is essential for developing effective, culturally appropriate crisis response strategies suited to Korea’s unique circumstances, while also informing international preparedness for similarly complex educational disruptions.

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