key: cord-0966831-fu31mgsg
authors: Lopyan, Natalie M.; Gadepalli, Samir K.; Perrone, Erin E.; Newman, Erika A.
title: Never the same – A commentary on surgical trainee well-being in the COVID era
date: 2021-08-28
journal: J Pediatr Surg
DOI: 10.1016/j.jpedsurg.2021.08.011
sha: 398d1d0a943abde5924bd03988a19b4a5b7b6676
doc_id: 966831
cord_uid: fu31mgsg

nan

guide their world through the perils of a global pandemic? Does anyone put on their scrubs hoping to sit beside someone's gasping wife… grandfather… brother so that they will not die alone? Physician wellness is already a vague term, but can we ever truly be "well" after a year like this? Much has been said about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on surgical trainees, but the degree to which this pandemic will continue to affect us for years to come remains unknown. One year ago, we arrived at the gates of the hospital parking lot and were met with signs proclaiming us as heroes. One year ago, we sat down to lunches provided by the local restaurants as a token of gratitude.

One year ago, passersby thanked us for our bravery and our service. However, as the world quickly tired of this new way of living, fraught with fear, isolation, and disruption, we watched as the communities that this virus ironically strengthened reverted to their old ways. Racism, sexism, and the political dividethere all along but quieted perhaps for a moment by a louder voice of camaraderie -prevailed.

As a result of COVID-19, the sense of belonging in the surgical community was diminished. Those who learn best by seeing, doing, and teaching were suddenly isolated while still in pursuit of their personal and organizational missions. To better accommodate the onslaught of COVID-19 patients, institutions cancelled non-urgent elective surgical cases, fostering anxiety among trainees about their case requirements and level of preparedness upon graduating. Additionally, with the reprioritization of health services, redeployment rates of surgical trainees varied nationwide, and not without a significant impact on their mental health as many were thrust into roles in which they felt unprepared [1] . Surgical residents lost the opportunity to participate in in-person conferences and were asked to obtain educational content virtually through webinars and online case presentations. Further, countless trainees were affected by board examination postponements and retakes, as the implementation of a remote online testing system met many obstacles. Though the risk of infection has decreased with vaccinations and access to personal protective equipment, the psychological impact on surgical trainees has yet to be mitigated. Mental health symptoms of anxiety, fatigue, and sleep disturbances were reported in trainees at all levels during the pandemic, and multiple surveys exposed their fears of contracting COVID-19 or transmitting it to family members [2] [3] [4] . Raised levels of personal sacrifice have brought with them an escalation in unquantifiable depression and suicide rates among trainees and faculty alike [5] . As our country returns to a pre-pandemic "normal", it would be cavalier to take such a milestone for granted, as the lives of trainees may not return to normal.

The COVID-19 pandemic has magnified disparities that existed well prior to its onset. Before the pandemic, women already assumed more of the household and childcare duties than their male counterparts -a discrepancy that did not spare academic women [6] . As childcare options dwindled due to school and daycare closures and the numbers of those seeking nanny and babysitting opportunities decreased due to fear of viral spread, mothers in medicine were disproportionately affected by the demand to balance home and work life in a way like never before. Women have assumed nearly twice as much responsibility for caring for their children at home compared with men [7] . As they bear the burden of orchestrating their children's education with a shift to remote, hybrid, or homeschooling models, the negative influence on the academic productivity of women physicians has a potentially long-lasting affect. Further, the financial consequences of the pandemic have become increasingly more inequitable with a 2.8% increase in medicine's persistent gender pay gap [8] .

As the pandemic mercilessly exposed the long-standing disparities in our nation's racial history, it also brought to light the additional burdens placed on Black, indigenous, and people of color (BIPOC) trainees. The pandemic offered no relief from the fight against the injustices of the medical profession's unresolved issues with race. Feelings of isolation already apparent from pre-existing workplace discrimination were compounded by battling a disease that disproportionately harmed the BIPOC community. Further, BIPOC physicians frequently care for relatively more BIPOC patients, and often in settings with less access to testing, treatments, and personal protective equipment [9] . With Black physicians comprising only 5% of the profession and 7% of all medical school students, a persistent lack of acknowledgement of the struggles endured by this community and a raging pandemic that effortlessly highlights those battles could directly decrease these already miniscule percentages [10] [11] .

The home-life dynamic has been altered by the COVID-19 pandemic in a way that would have previously been unimaginable. The idea of isolation for months would be daunting and depressing even without the added element of the indefinite nature of its timeline. The lack of in-person human interaction over the past year was felt by all, and surgical trainees were no exception. As they devote their lives to an already grueling and demanding profession, the ability to seek comfort and support from those they love is of paramount importance. Such comfort and connection were significantly hampered by the restrictions inflicted by the pandemic. Many made the impossible decision of self-isolating away from significant others, children, and parents to protect the health and safety of those they care for most. The stress experienced by many trainees was heightened by an extension of work into home life, as lingering images and emotions from a day spent gowned, gloved, masked and potentially afraid insinuated themselves into interpersonal relationships. While the tell-tale marks of a day spent wearing an N95 respirator disappear with time, the pandemic has left marks on the lives of surgical trainees that may take longer to fade.

One year ago, COVID-19 became a reality in our lives. After a year of mental and physical anguish for so many, we have finally begun to see the light of a new day. But as we look forward to the dawn of that new day, we must not forget those whose lives were lost over this last year, and we must not forget those whose ways of living were forever changed by this pervasive illness. One can only hope that as we arrive at the other side, we do so with the empathy, sympathy, compassion, and grace that we felt for each other, and ourselves, one year ago, when this pandemic was in its infancy, and we had no choice but to act as one. If we can do that, we will never be the same, and should certainly be lauded as heroes.

The impact of COVID-19 on surgical training: a systematic review

The lasting footprint of COVID-19 on surgical education: a resident and attending perspective on the global pandemic

How resilient is your team? Exploring healthcare providers' well-being during the COVID-19 pandemic

Stress and the surgical resident in the COVID-19 pandemic

The impact of COVID-19 on women surgeons and trainees: The transformation of medical students, surgical residents, and attending surgeons

Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers

13302: baby steps: the gender division of childcare during the COVID-19 pandemic

Doximity 2020 Physician Compensation Report -Fourth Annual Study

The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions: Summary of the Symposium on Diversity in Health Professions in Honor of

Percentage of all active physicians by race/ethnicity

AAMC Applicant Matriculant Data File. Percentage of acceptees to U.S. medical schools by race/ethnicity (alone), academic year