Nineteen perspectives on COVID-19: How the pandemic impacted women in training for plastic and reconstructive surgery

02 Dec 2020

By the Johns Hopkins University School of Medicine medical students and Plastic and Reconstructive Surgery residents: Erica Lee, Helen Xun, Sai Pinni, Pooja Yesantharao, Chao Long, Wilmina Landford, Franca Kraenzlin, Amy Quan, Jonlin Chen, Darya Fadavi, Waverley He, Faraah Bekheet, Kristen Broderick, and others.

The glass ceiling found an ally in a virus that arrested the world. Together, these challenges are as detrimental as they are invisible. Although the pandemic’s long-term effects on women in surgery are unclear, COVID-19 has the potential to magnify micro-inequalities that women  in surgery already face, as the resulting stay-at-home orders disproportionately burden women with housework and childcare (Lewis 2020). Female trainees navigating the stages necessary to establish successful surgical careers face additional uncertainty due to the loss of networking and mentorship opportunities (Brubaker 2020).

We interviewed 19 women from the Johns Hopkins School of Medicine in various stages of training in Plastic and Reconstructive Surgery (PRS) on their experiences with COVID-19. This cohort represented diverse personalities, cultures, and motivations; despite these differences, it was clear that each woman held in common an adamant refusal to allow the pandemic to be an obstacle in their career development and training. Together, we share the barriers COVID-19 has created and our concerns for the future.

Seeking opportunity through adversity

A loss of training in medical school and surgical residency: As COVID-19 restrictions at institution and state levels evolve, medical education is in a constant state of flux. While pre-clinical courses translated well onto Zoom platforms, trainees in the midst of clinical rotations and surgical residency  received a substantial blow to experiences in exploring surgical fields and gaining confidence in a variety of procedures. One PGY2 reported she “did not feel [she] was getting a good training experience” due to the low surgical volume and cancelled cases. However, the valued time in the hospital is juxtaposed with fear of COVID-19 exposure and bringing the virus home.

A loss of tradition: The interview trail is arguably a competitive rite of passage for both medical students and residents applying to fellowship. This brings an opportunity to know the larger PRS community and invites self-discovery as impactful career choices unfold. One medical student was concerned by the lack of “opportunity [to visit] programs in person” as in-person interviews allow an opportunity to showcase professional accomplishments and goals, meet future colleagues, and understand the culture of programs. The pandemic converted the already daunting application cycle into an enigma of novelty: an entirely virtual platform. While blanket guidelines from societies provided some comfort in defining the final form, the trainees agreed that “virtual is necessary,” but continued to wonder “is it also sufficient?”

New research opportunities: Across the board, trainees had to refocus and restructure their research due to non-essential research restrictions and shutdowns. Trainees continued to develop projects that could be completed at home, and one trainee even took the opportunity to repurpose her 3D printing lab to produce COVID-related devices and personal protective equipment. Although limited research funding added additional pressures to trainees, for some residents, the prospect of a difficult research year seemed more appealing than a clinical year with reduced surgical volume.

Rebalancing identity as a surgeon and a mother

While medical students used stay-at-home orders to volunteer and spend time with family, female trainees with children had to balance parenthood with working from home. As daycares closed, resident moms found their free time occupied with childcare while their fellow residents were able to study or complete research during their new found free time. One expecting resident anticipates the effects of COVID-19 on her surgical training will only be compounded by her upcoming maternity leave. Another resident found herself teaching her toddler the alphabet instead of learning to dissect a muscle flap and expressed a loss of confidence in surgical skills, as well as in her identity as a surgeon.

Looking to the future

Although trainees who are in earlier stages of their training believe that there is time to “bounce back” and accomplish their goals, those who are near career milestones are concerned by the impact newfound challenges in visibility and productivity will have on their next career stage.  Despite these challenges highlighted by COVID-19, an overwhelming theme expressed by students and trainees is the optimism that they will adapt to the “new normal” and overcome obstacles that arise as the pandemic progresses.

Our collective narrative illuminates how the COVID-19 pandemic has impacted aspiring female plastic surgeons’ education and shaped their concerns for the future. We highlight the resilience of women in surgery and their determination to seek opportunity from adversity. While many of the challenges voiced might not necessarily be gender specific, it is critical to recognize that they could disproportionately affect female trainees. We challenge mentors, departments, and institutions to consider these themes in order to provide additional support for women in surgery. As a community, we can work to ensure that as we work to flatten the pandemic curve, we do not also flatten the momentum to close the gender gap in surgery.

Pictured Left to Right: Dr. Wilmina Landford PGY4, Helen Xun MS4, Pooja Yesantharao MS4, Erica Lee MS2, Darya Fadavi MS2, Sai Pinni MS0. Photo Credit to Will Kirk of the Johns Hopkins University.
Pictured Left to Right: Dr. Wilmina Landford PGY4, Dr. Hillary Jenny PGY3. Photo Credit to Will Kirk of the Johns Hopkins University.
Timeline of Women in PRS: The timeline illustrates the milestones leading up to a career in PRS and the diversity of our respondents in where they fall on that path.
Experiences at a Glance: The diagram highlights select quotes from respondents across the timeline.
Pictured Left to Right: Darya Fadavi MS2, Pooja Yesantharao MS4, Helen Xun MS4, Dr. Wilmina Landford PGY4, Sai Pinni MS0. Photo Credit to Will Kirk of the Johns Hopkins University.

About the authors: Medical students Erica Lee, Helen Xun, and Sai Pinni had the honor of interviewing the women of the Plastic and Reconstructive Surgery residency program at the Johns Hopkins School of Medicine and their fellow medical students interested in pursuing careers in Plastic and Reconstructive Surgery. Under the guidance of Dr. Kristen Broderick, a plastic and reconstructive surgeon and Director of Breast Reconstruction at the Johns Hopkins Bayview Medical Center, they have built combined insights from those interviews into this collective narrative. The 19 women featured in the narrative have a wide range of passions, including painting and yoga, and hold a variety of research interests from engineering to improving diversity in breast reconstruction patient education to optimization of resident aesthetic clinics. The authors are appreciative of the Johns Hopkins School of Medicine’s diverse and enriched environment that emphasizes community building. Collectively, they enjoy yelp’ing through Baltimore’s cuisines and walks along the Chesapeake Bay. The Johns Hopkins University/University of Maryland Plastic Surgery Residency Program can be followed on Instagram @hopkinsplasticsurgery. You can find individual authors on Instagram @elee113, @slpinni27, @hellohelen1958, @heyitschao, @landfordmd, @jonlinchen, and @kpbroderick or via Twitter @helen_xun and @chaolong.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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