COVID-19 Changed How We Engage with Our Professional Societies and Each Other

Highlights

• Describes the effect of COVID-19 on membership participation in surgical societies
• Summarizes how professional society involvement may enhance mental health during the pandemic
• Outlines engagement opportunities supported by the RAS-ACS

COVID-19 undoubtedly forced surgical residency training programs to restructure their workflows to meet the general demands of their hospitals.¹ Anesthesia providers, nursing staff, and surgical residents at many institutions were redeployed to the wards to care for COVID-19 patients. Furthermore, staff shortages secondary to personnel infected with or exposed to the virus limited the ability of residents, fellows, and attendings to perform operative cases. Simulation and in-person didactic conferences were prohibited because of quarantine regulations, which compounded the detrimental impact on surgical education.^2,3

In a recent article by Coleman and colleagues, 96% of residents and young attendings reported that COVID-19 negatively affected their clinical experience, with 84% of residents reporting a more than 50% reduction in operative volume at the beginning of the pandemic.⁴ Many respondents also reported negative effects on personal wellness.⁴ As we seem to begin experiencing an ebb in the outbreak, it is uncertain how pervasive these repercussions will be in the future.

Although the clinical demands of the pandemic resulted in lulls in surgical workflow, trainees saw the opportunity to embrace wellness and extracurricular activities.^5,6 Many trainees were even able to attend international research conferences via virtual platforms, which would otherwise have been precluded because of time and budget constraints. These findings beg the question of the impact the pandemic had on membership participation in surgical societies. Did members look to their societies, such as the American College of Surgeons (ACS) and Resident and Associate Society (RAS), for support or a sense of community during the pandemic? How might surgical societies play a better role in mental health? Likewise, did surgical societies rise to the occasion and adapt to the needs of their members?

This article discusses the effect the pandemic had on member participation in surgical societies and interpersonal professional relationships. It also suggests different opportunities to connect with other members through the various platforms RAS-ACS offers.

Involvement in Professional Societies

The survey posed five specific questions intended to elucidate the perception of RAS Member participation in professional societies because of the pandemic. A total of 334 RAS members recorded responses to each question. The core question (Q1) was: “How have you felt your participation in professional societies has changed since the COVID-19 pandemic?” Most RAS Members (60%) reported decreased participation, whereas only 13% reported increased participation. When asked to indicate any change in the number of active memberships in dues-paying professional societies (Q2), a similar amount of RAS members (15%) reported increased quantity in addition to increased overall participation, whereas the majority (68%) reported no change. Only 17% reported a decrease in the number of active professional society memberships.
Interestingly, when RAS members were asked about their perception of peer involvement in professional societies, answers varied. Most respondents thought that peers at or below their training level were more involved, 33% and 39%, respectively. RAS Members’ perception of individuals above their training level most closely resembled self-reported participation, with only 9% perceiving increased professional society involvement among more senior residents and 68% perceiving decreased involvement.

Training Level and Professional Society Membership

A subgroup analysis of RAS Members was performed to evaluate the interplay of trainee level and changes observed in professional society participation. Survey respondents were grouped into four trainee categories by postgraduate year (PGY): junior (PGY-1‒2), senior (PGY-3‒5), fellow (PGY-6 or above), or research. A total of 328 survey respondents provided both their PGY level and how their individual participation in professional societies has changed during the COVID-19 pandemic.

Overall, professional society participation decreased, with 60% of senior residents and 69% of fellow trainees noting a decline in participation. Research residents tended to be more involved in their professional societies, with only 46% noting a decline in participation (see Figure 1). Interestingly, respondents who did report increased participation said it was incremental among more senior trainee groups. For example, fellows reported the largest percentage of increased professional society involvement at 24%, eight times as frequently as junior residents at 3% and twice as often as senior residents (13%). However, the percentage of research residents who reported increased professional society membership most closely resembled the response of fellows, with 24.2% of respondents self-reporting increased professional society participation.
In addition, RAS members were asked to quantify the number of professional society memberships they maintained during the pandemic. A total of 311 survey respondents answered both the trainee-level question and how their quantity of professional society memberships had changed during the COVID-19 pandemic (see Figure 2).

Overall, the most frequent response was that respondents did not experience a change in the quantity of professional society memberships they maintained, ranging from 52% of fellows to 76% of junior residents. Again, a positive correlation was observed in those reporting an increase in the quantity of professional society memberships and more senior trainees. For example, 5% of junior residents reported an increase in the quantity of professional society memberships versus 15% of senior residents and 21% of fellows, corresponding to a rate four times greater than that of junior residents. Unsurprisingly, research residents reported the greatest increase in the quantity of professional society membership at 28%. These findings suggest that trainees maintained previous professional society memberships, but also appeared to withdraw from ongoing participation in those organizations.

Mental Health and Professional Society Membership

Professional society participation may play a significant role in mental health during the COVID-19 pandemic. When examining the connection between professional society involvement and mental health, a few findings stood out. First, in the cohort of survey respondents who reported an increase in professional society memberships, the incidence of self-reported anxiety and depression both were significantly lower than those who reported a decrease or no change (see Figure 3). Among survey respondents who reported a decrease in the quantity of society memberships, 75% reported experiencing symptoms of anxiety, 61% reported no change in anxiety, and 43% reported an increase in anxiety (p = 0.009).

Self-reported symptoms of depression followed a similar pattern. Among respondents who reported decreased society involvement, 70% reported feeling depressed, in contrast to 43% of the respondents who were more engaged (p = 0.024). No significant differences in self-reported sleep disturbances, appetite changes, anhedonia, or weight change were reported. Further investigation would be needed to evaluate the impact of professional societies on the mental health of their members, as these findings could simply reflect the propensity of those with fewer symptoms of anxiety or depression to be more likely to engage in extracurricular activities. Nonetheless, these findings highlight the significant role professional societies and communities play in the well-being of surgical trainees.

Key Themes

Five key themes were identified in relation to the positive and negative effects of the pandemic: personal wellness, relationships, social media, academic/career activities, and nonacademic extracurricular activities (see Figure 4). Social media and academic/career activities are beyond the scope of this article; following is a deeper dive into the other themes.

Personal Wellness and Relationships

Trainees and early career surgeons described COVID-19’s impact on personal wellness. Overall, the overwhelming majority of surgical trainees (84%) expressed a negative effect on personal wellness, in contrast to most early career surgeons (65%) reporting having experienced a positive impact on personal wellness during the pandemic. However, 90% of trainees and 68% of Associate Fellows reported that the pandemic negatively affected their personal and professional relationships.

Although most residents were on one end of the personal wellness spectrum, considerable variability in the degree of negative impact they experienced was discernible (see Table 1). Many described “feel[ing] lonely a lot more…and not [being] able to have outings to decompress like [they] used to.” Others described themselves as “just trying to get through.” Other respondents expressed “less wellness, less free time” because of “fear of contracting illness and causing resident/fellow shortages on service.”

Some respondents did express that they had more leisure time, but in the context that they were “more motivated to completely disconnect from work and coworkers in [their] free time” and “less resident bonding.” Others leaned on ACS membership to help them, stating, “If I wasn’t involved in RAS, my only connection to other peers would be through random virtual fellowship interviews and associated group chat.” This response highlights the importance of professional societies in promoting fellowship and connection. Training is difficult and having a support system, both among fellow trainees and mentors, is crucial to the development of a surgeon today.⁷

In contrast, early career surgeons indicated that the pandemic had a positive effect on their personal wellness. Many expressed “[having]…more time to spend with family,” while noting that “virtual meetings (such as weekly conferences) [were] much easier to attend” and they were “more deliberate about contacting peers and proactively scheduling time to connect.”

This positive impact on personal wellness and leisure time may have naturally improved for recent graduates from residency. Still others described becoming “more health attentive [because] we have to take care of ourselves first in order to save patients.” In terms of relationships, many respondents found it “more difficult to connect personally to peers” with “decreased networking [leading] to less career/professional satisfaction.” However, a number of respondents noted “societies like ACS and [the Society of American Gastrointestinal and Endoscopic Surgeons]…allowed [them] to connect with peers internationally.” Others “discovered other avenues leading to more mentorship.” Similar to trainees, the personal interaction with colleagues and mentors, through professional societies and otherwise, is important, in particular because the pandemic hindered in-person interactions.

Social Media

Both trainees and Associate Fellows described an increase in social media use. A frequent reason both groups cited was to maintain “communication with peers,” participation in virtual conferences, and “as an escape from the stress and overwhelming sadness that COVID brought.” Although trainees and Associate Fellows increased their use of social media, they mentioned the virtual platforms were “much less engaging and stimulating academically” and as a result “decreased the drive to stay involved.” The social media platforms most frequently cited were Twitter, Instagram, and different messaging tools (WhatsApp, Microsoft Teams, and text).

Conclusion

This survey highlights the impact of the COVID-19 pandemic on the surgical trainee and early career surgeon experience. The degree of stress and frustration related to the pandemic cannot be overstated. Its toll was apparent not only through the significantly reduced socialization and ability to relieve stress through extracurricular activities, but also through increased clinical responsibilities for many residents and young surgeons. Trainees and early career surgeons looked to professional societies, social media, and other outlets to provide a sense of community and belonging.

Although virtual platforms will never replace the in-person experience, surgical societies such as the ACS and RAS have stepped up during the pandemic and continue to meet the needs of their members. The pandemic has made evident the value of being part of a professional society. @RASACS, the Twitter account of RAS-ACS, not only disseminates knowledge in an easy-to-digest format, but also is a resource for upcoming events such as webinars and virtual conferences.

RAS-ACS also started a monthly Hangout, where medical students and residents can meet online for a casual conversation to learn about different surgical specialties and other topics of interest. The RAS-ACS Journal Club is a joint venture with the Journal of the American College of Surgeons that was developed to engage trainees and junior attendings with current surgical literature through discussion with experts from around the world. Finally, members can get involved in a variety of committees that work on annual projects that help give surgical trainees and early career surgeons a voice to shape the future of surgery. Find more information at facs.org/ras-acs. 

References

1. 1. Juprasert JM, Gray KD, Moore MD, et al. Restructuring of a general surgery residency program in an epicenter of the coronavirus disease 2019 pandemic: Lessons from New York City. JAMA Surgery. 2020;155(9):870–875.
2. Ellison EC, Spanknebel K, Stain SC, et al. Impact of the COVID-19 pandemic on surgical training and learner well-being: Report of a survey of general surgery and other surgical specialty educators. J Am Coll Surg. 2020;231(6):613–626.
3. Aziz H, James T, Remulla D, et al. Effect of COVID-19 on surgical training across the US: A national survey of general surgery residents. J Surg Ed. 2021;78(2):431–439.
4. Coleman JR, Abdelsattar JM, Glocker RJ, RAS-ACS COVID-19 Task Force. COVID-19 pandemic and the lived experience of surgical residents, fellows, and early-career surgeons in the American College of Surgeons. J Am Coll Surg. 2021;232(2):119-135.e20.
5. Maghfour J, Olson J, Jacob SE. COVID-19 impacts medical journal submissions. J Womens Dermatol. 2020;6(4):255–256.
6. Palayew A, Norgaard O, Safreed-Harmon K, et al. Pandemic publishing poses a new COVID-19 challenge. Nature Human Behaviour. 2020;4(7):666–669.
7. Rajendran L, Jones D, Brar S. Junior mentorship program (JuMP) start in surgery—implications on trainee success. J Surg Educ. May 4, 2022 [Epub ahead of print]. Available at: https://bit.ly/3PMSia7. Accessed June 29, 2022.

Dr. Nathan Rubalcava is a general surgery resident at Creighton University-Phoenix Regional Campus, AZ. He is Vice-Chair, RAS-ACS Membership Committee.