By Deborah Rupert, MS, MA
The impact of the COVID-19 pandemic on women physicians has sparked ongoing discussions about gender-disproportionate personal burdens (Soares, et al, 2021) and professional consequences on academic publication rates (“productivity”) (Andersen, et al, 2020; Ipe, et al, 2021; Krukowski, et al, 2021), compensation (Woodhams, et al, 2020) and promotional track advancement (Narayana, et al, 2020).
However, less discourse has focused on the pandemic’s toll on women trainees in their medical school years. Instead, literature investigating the pandemic’s impact at the undergraduate medical education (UME) level has largely pooled medical students and discussed adaptive curriculum (Lin, et al, 2021; Sani, et al, 2020; Compton, et al, 2020; Miller, et al, 2020). This has resulted in knowledge gaps, outlined herein, as to the unique challenges faced by the next generation of women in medicine.
First and foremost, we must acknowledge and appreciate that the pandemic has cast intersectional feminism in medicine into the spotlight. As the economic (AAMC, 2018) and racial diversity (Lett, et al, 2019) of UME matriculants has increased in recent years, we must consider the population of trainees whose home lives, families and communities were hit hardest by the pandemic, including Black and Latinx students as well as those living in poverty (Abraham, et al, 2021). Racially diverse UME students were faced with balancing the demands of their medical education, racial unrest and a global pandemic; this has contributed to the significant mental and emotional burdens carried by historically underrepresented minority (URM) trainees (Salahou, et al, 2021; Stowers, et al, 2021). These issues are compounded by the disproportionate caretaker and mental health challenges of women trainees; women URM at the UME level are more likely to have become caretakers due to the pandemic and face mental health issues in the face of dire consequences to their families and communities (Robinson, et al, 2021). Moreover, it is likely, though poorly documented, that women trainees and/or their families have disproportionately faced financial struggles resulting in housing or food insecurities, because of the pandemic. These are highly complex, often hidden and under-investigated issues that likely increased for URM, women and URM-women trainees over the past year and a half.
Likewise, while the pandemic has worsened the mental health of UME students as a group (Meo, et al, 2020; Gupta, et al, 2021; Harries, et al, 2021), several lines of evidence support the conclusion that women trainees collectively experienced greater pandemic-exacerbated mental stress and illness than their male colleagues (Abdulghani, et al, 2020; Alsoufi, et al, 2020). This exacerbation of mental health issues is intimately linked to disproportionate, gender-biased emotional and mental loads as women are more likely to face caretaker burdens. According to the 2020 AAMC Questionnaires, 3.1 percent of entering and 7.3 percent of graduating UME students respectively have a non-spouse dependent. Given that since 2019 the majority of medical school matriculants in the United States are women (Durfey, et al, 2021; Glauser, 2019; Taylor, 2013), it is likely that the majority of medical-student parents are women. However, the gender breakdown of parenthood among UME trainees is not well documented. (The exact gender breakdown of the student-parent population, however, is not reported by the AAMC in their annual Graduation or Matriculating questionaries.) How the training of student-physician parents, specifically mothers, was impacted during the pandemic has been the focus of sparse investigative work (Murphy, 2020). Likewise, the percentage of UME women who became parents during the pandemic specifically has not been determined. Further, bridging curricular adaptations for this population over the past year and a half has the potential to drive more long-term, institutional reforms (Arowoshola, 2020; Lin, et al, 2021).
Finally, it bears mentioning that in addition to their own experiences, women UME students have witnessed the pandemic’s well-documented consequences on the career trajectories of early-, mid- and late-career women mentors. What does it mean to watch those we respect so much struggle to find institutional and personal support while fighting on the front lines of a public health crisis? The advocacy efforts by women in medicine, on their own behalf as well as their peers’, often have important downstream ripple effects that reach far beyond the walls of any individual institution. Like women physicians, women medical students are just beginning to parse out what recovery in the wake of the pandemic’s gender-driven consequences will look like, both professionally and personally. Therefore, as the community of women in medicine begins to fight for solutions-focused initiatives (Narayana, et al, 2020), we must urge a sense of unity across levels of training.
- Abdulghani, H.M., Sattar, K., Ahmad, T., Akram, A. (2020 October 30). Association of COVID-19 Pandemic with Undergraduate Medical Students’ Perceived Stress and Coping. Psychology Research and Behavior Management. DOI: 10.2147/PRBM.S276938
- Abraham, P., Williams, E., Bishay, A.E., Farah, I., Tamayo-Murillo, D., Newton, I.G. (2021 May 11) The Roots of Structural Racism in the United States and their Manifestations During the COVID-19 Pandemic. Academic Radiology. DOI: 10.1016/j.acra.2021.03.025
- Alsoufi, A., Alsuyihili, A., Msherghi, A., Elhadi, A., Atiyah, H., et al. (2020 November 25) Impact of the COVID-19 Pandemic on Medical Education: Medical Students’ Knowledge, Attitudes, and Practices Regarding Electronic Learning. PLOS ONE. DOI: 10.1371/journal.pone.0242905
- Andersen, J.P., Nielsen, M.W., Simone, N.L., Lewiss, R.E., Jagsi, R. (2020 June 15) COVID-19 Medical Papers Have Fewer Women First Authors Than Expected. eLife. DOI: 10.7554/eLife.58807
- Arowoshola, L. (2020 December 25) Medical Education Engagement During the COVID-19 Era – A Student Parents Perspective. Medical Education Online. DOI: 10.1080/10872981.2020.1788799
- Association of American Medical Colleges. (2018 October) An Updated Look at the Economic Diversity of U.S. Medical Students. AAMC Analysis in Brief. https://www.aamc.org/media/9596/download
- Centers for Disease Control and Prevention. (2020 December 10) COVID-19 Racial and Ethnic Health Disparities. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html
- Compton, S., Sarraf-Yazdi, S., Rustandy, F., Radha Krishna, L.K. (2020 June 10) Medical Students’ Preference for Returning to the Clinical Setting During the COVID-19 Pandemic. Medical Education. DOI: 10.1111/medu.14268
- Durfey, S.N.M., White, J., Adashi, E.Y. (2021 February 9) Pregnancy and Parenting in Medical School: Highlighting the Need for Data and Support. Academic Medicine. DOI: 10.1097/ACM.0000000000003988
- Glauser, W. (2019 February 25) How Medical Schools Can Better Support Students Who Are Parents. CMAJ. DOI: 10.1503/cmaj.109-5707
- Gupta, P., Anupama, B. K., Ramakrishna, K. (2021 May 2) Prevalence of Depression and Anxiety Among Medical Students and House Staff During the COVID-19 Health-Care Crisis. Academic Psychiatry. DOI: 10.1007/s40596-021-01454-7
- Harries, A.J., Lee, C., Jones, L., et al. Effects of the COVID-19 Pandemic on Medical Students: A Multicenter Quantitative Study. BMC Medical Education. DOI: 10.1186/s12909-020-02462-1
- Ipe, T.S., Goel, R., Howes, L., Bakhtary, S. (2021 February 1) The Impact of COVID-19 on Academic Productivity by Female Physicians and Researchers in Transfusion Medicine. Transfusion. DOI: 10.1111/trf.16306
- Krukowski, R.A., Jagsi, R., Cardel, M.I. Academic Productivity Differences by Gender and Child Age in Science, Technology, Engineering, Mathematics, and Medicine Faculty During the COVID-19 Pandemic. Journal of Women’s Health. DOI: 10.1089/jwh.2020.8710
- Lett, L.A., Murdock, H.M., Orji, W.U., Aysola, J., Sebro, R. (2019 September 4) Trends in Racial/Ethnic Representation Among US Medical Students. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2019.10490
- Lin, H.C., Zeanah, P.L., Olivier, D.F., Bergeron, M.A., Liu, C.H. (2021 February 5) Responding to the Pressing Yet Unrecognized Needs of Student-Parents Amid the COVID-19 Pandemic. Journal of American College Health. DOI: 10.1080/07448481.2020.1870474
- Meo, S.A., Abukhalaf, A.A., Alomar, A.A., Sattar, K., Klonoff, D.C. (2020 May) COVID-19 Pandemic: Impact of Quarantine on Medical Students’ Mental Wellbeing and Learning Behaviors. Pakistan Journal of Medical Sciences. DOI: 10.12669/pjms.36.COVID19-S4.2809
- Miller, D.G., Pierson, L., Doernberg, S. (2020 July 1) The Role of Medical Students During the COVID-19 Pandemic. Annals of Internal Medicine. DOI: 10.7326/M20-1281
- Murphy, B. (2020 May 7) Medical Student Moms Face Challenge of Pandemic Parenthood. AMA. https://www.ama-assn.org/residents-students/medical-school-life/medical-student-moms-face-challenge-pandemic-parenthood
- Robinson, L.J., Engelson, B.J., Hayes, S.N. (2021 February 23) Who is Caring for Health Care Workers’ Families Amid COVID-19? Academic Medicine. DOI: 10.1097/ACM.0000000000004022
- Salahou, A., Rahmon, D., Fedorowicz, M. (2021 May 1) Medical Students Confront Racism and Systemic Oppression Amidst a Global Pandemic. Academic Medicine DOI: 10.1097/ACM.0000000000003966
- Stowers, J.A., Desrosiers, S., Zeleke, K., Bakare, O., Seifi, A. (2021 February) The Life of a Black Medical Trainee in the United States: Past, Present, Future. Journal of the National Medical Association. DOII: 10.1016/j.jnma.2020.07.004
- Soares, A., Thakker, P., Deych, E., Jain, S., Bhayani, R.K. (2021 May 7) The Impact of COVID-19 on Dual-Physician Couples: A Disproportionate Burden on Women Physicians. Journal of Women’s Health (Larchmont). DOI: 10.1089/jwh.2020.8903
- Taylor, J., Macnamara, M., Groskin, A., Petras, L. (2013 March 1) Medical Student-Mothers. Rhode Island Medical Journal. http://rimed.org/rimedicaljournal/2013/03/2013-03-42-cont-medmothers.pdf
- Woodhams, C., Dacre, J., Parnerkar, I., Sharma, M. (2021 January 9) Pay Gaps in Medicine and the Impact of COVID-19 on Doctors’ Careers. Lancet. DOI: 10.1016/S0140-6736(20)32671-4
Deborah Rupert, MS, MA
An MD-PhD trainee in the Medical Scientist Training Program at Stony Brook University’s School of Medicine. She is completing her graduate studies at Cold Spring Harbor Laboratory (CSHL). She has a Master of Science in Human Nutrition from Columbia University and a Master of Arts in Biotechnology, also from Columbia University. She is the President Emerita of CSHL’s Women in Science and Engineering group and served on the leadership of that organization for three years. She is currently serving her sixth year on the Executive Board of New York University-Winthrop’s Wellness Initiative Student-Run Health Clinic (WISH), an organization dedicated to providing healthcare to the poor and uninsured on Long Island. Rupert currently volunteers as the WIMS’ Research and Grants Lead.
Follow Ms. Rupert