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Background The COVID-19 pandemic forced medical education to rapidly transition from in-person learning to online learning. This change came with learning difficulties, social isolation, limited student/faculty relationships, and decreased academic performance. Objective The purpose of this study is to determine if academic performance, study habits, student/faculty relationships, and mental health were different in first-year medical students (class of 2024) during the COVID-19 pandemic compared to pre-COVID cohorts. Methods In April 2021, a survey was sent to first-year medical students at the Kirk Kerkorian School of Medicine at UNLV asking them to reflect on their experiences during the COVID-19 pandemic including study environment, mental health, and relationships with peers and faculty. A similar survey was sent to second- and third-year medical students (classes of 2023 and 2022) asking them to reflect on similar experiences during their first year of medical school. Exam scores for the first five exams were gathered and compared between first-, second-, and third-year medical students. Results One hundred twenty-five students responded to the survey (81% of first-year students, 75% of second-year students, and 55% of third-year students). During the COVID-19 pandemic, first semester students did not score above the national average as much as first semester students pre-COVID (55% vs. 77%). Students during the pandemic studied at home more than previous cohorts. Mental health and relationships were all rated significantly lower among first semester students during the COVID-19 pandemic. Conclusions Significant differences were found in first semester student experience and academic performance during the pandemic compared to pre-COVID cohorts.