We read with great interest the research by Cao et al [1] , on their insightful study on the psychological impact of the COVID-19 epidemic on medical students in China. We as medical students studying in our penultimate year in the UK, have reflected on our own experiences during such unprecedented times. It is especially during these times of uncertainty where we feel an overwhelming sense of duty to support our National Health Service (NHS), in any way we can. But the fear and anxiety of what we are to face is not eased by the sheer number of sensationalised news headlines and erroneous news reports. Cao et al excellently address some of these issues, however the confounding factors we have identified may have implicated the validity of the study.
Firstly, the target population of the study were undergraduates of Changzhi Medical College but no inquiry was made into their year of study. It would prove interesting to see if anxiety levels do change between the younger and older students, and if variances in work-load and pressures between year groups have been overlooked and thus characterised as COVID-19 related. Chandavarkar et al [2] identified in their study that medical students transitioning from pre-clinical to clinical years displayed the highest numbers in anxiety, attentional and depressive symptoms. From our own reflections, we can understand why this may be the case. The continual change in clinical sites, engagement with new supervisors and familiarity with different peers of our cohort, added to the vast amount of knowledge and competency of practical skills required, can place significant pressures if not managed accordingly.
Furthermore, it might have been beneficial for the authors to identify individuals with preexisting mental health problems. As the sample's 24.9% anxiety occurrence, may have been exacerbations of pre-existing mental health issues rather than new onset problems. A metaanalysis by Zeng et al [3] summarising the prevalence of mental health problems in Chinese medical students suggested a 21% prevalence of anxiety and it is well established that mental health issues are more prevalent within the medical field and medical schools are continuously striving to tackle this problem.
The study has been an interesting likeness to some of our own experiences as medical students from Imperial College London. It raises important questions regarding mental health, as institutions and businesses close and we quarantine ourselves to the safety of our own homes. The vast amount of incorrect information circulating the internet to the shortage of supplies, adds negatively to our own health and well-being [4] . It is due to the uncertainty of times that is intensifying those worries, but universities and educational leads can mitigate this by regularly updating their students and colleagues on what is happening regarding the future of their course or programme. Importance of social support should not be neglected and we are in an era where we can communicate and be there for one another, without being physically present.