Dear Program, What I Wish You Would Do: Applicants' Concerns About and Suggestions for Applying to Surgical Residency During COVID-19.

SURGICAL PERSPECTIVE Dear Program, What I Wish You Would Do: Applicants’ Concerns About and Suggestions for Applying to Surgical Residency During COVID-19 Cheryl K. Zogg, MSPH, MHS,  yY and Sharon L. Stein, MD, FACS, FASCRSz§, 2020-2021 National Medical Student Committee of the Association of Women Surgeonsô Keywords: COVID-19, ERAS, match, medical student, residency, surgery, virtual (Ann Surg 2021;273:e85–e87) T he COVID-19 pandemic dramatically changed the progression of medical education for applicants applying to surgical residency this year, including upheavals in clerkship, research, and sub-internship training; cancellation of away rotations; delays and limited access to testing centers; uncertainty about the application process; and related concerns about what it means to do a fourth-year while grappling with virtual interviews and sub-internships, a travel-less match, and the broader reality of the current crisis affecting the world today. Whether interested in general surgery or an integrated operative field, residency applicants and programs are unsure of how best to prepare for and manage this year. A growing body of literature has attempted to anticipate challenges that surgical applicants might face1 –3 and draw from experiences gained through the fellowship match to offer insight from both programs’4 –6 and applicants’7 perspectives. Nevertheless, despite careful planning and well-intended advice, there remains a dearth of ‘‘safe places’’ in which applicants can make their voices heard. Rapid propagation of programs’ presence on social media and the development of virtual offerings ranging from webinars and open houses to attendance of grand rounds and case conferences have forever changed how applicants and programs interact. It has yielded From the Chair, National Medical Student Committee, Association of Women Surgeons, Chicago, Illinois; yYale School of Medicine, New Haven, Connecticut; zPresident, Association of Women Surgeons, Chicago, Illinois; §Division of Colon and Rectal Surgery, University Hospitals, Cleveland Medical Center, Cleveland, Ohio; and ôAssociation of Women Surgeons, Chicago, Illinois. . Author contributions: Zogg, Stein, and the 2020-2021 National Medical Student Committee of the Association of Women Surgeons (AWS) made substantial contributions to the conception or design of the work. Zogg, Stein, and AWS participated in the acquisition and analysis of the data. Zogg, Stein, and AWS contributed toward the interpretation of data for the work. Zogg drafted the manuscript, and Stein and AWS critically revised the manuscript for intellectual content. All authors provided final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Cheryl K. Zogg, MSPH, MHS, is supported by NIH Medical Scientist Training Program Training Grant T32GM007205. She is the PI of an F30 award through the National Institute on Aging F30AG066371 entitled ‘‘The ED. TRAUMA Study: Evaluating the Discordance of Trauma Readmission and Unanticipated Mortality in the Assessment of hospital quality.’’ Sharon L. Stein, MD, FACS, FASCRS, has received funding from Merck, Sharp & Dohme, and Medtronics. The authors report no conflicts of interest. Copyright ß 2021 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/21/27303-0e85 DOI: 10.1097/SLA.0000000000004685 Annals of Surgery  Volume 273, Number 3, March 2021 a variety of responses ranging from excitement and motivation to a sense of obligation and fear of missing out. Although some applicants have embraced the trend, others have intentionally stayed away not wanting to deal with the added stress and distraction as application and interview deadlines loom all while worried that in turning away or in not being active on social media in the first place their opportunity to match will be harmed. In writing this perspective, we wanted to take a different approach, providing an anonymous forum through which applicants could make their voices heard. Using repeated posts to social media (Instagram and Twitter), emails sent by the professional society to medical student members of the Association of Women Surgeons (AWS), and personal emails forwarded through our network of medical student chapters, the AWS National Medical Student Committee reached out to applicants applying for residency in general surgery or an integrated operative field (including but not limited to: cardiothoracic, vascular, plastics, orthopedics, otolaryngology, ophthalmology, urology, obstetrics and gynecology, and neurosurgery) during the 2020 to 2021 application cycle, asking what applicants wish that programs would do. Between June and September 2020, 468 applicants responded, filling out an anonymous online Qualtrics free-response survey (informed-consent required) that asked:  ‘‘What concerns do you have about applications unique to this year?’’  ‘‘What do you wish that programs would do to improve the application process during COVID-19?’’ Qualitative thematic analysis of their responses discussing 5 major concerns and an accompanying ranked list of 10 suggestions of things that applicants are looking for from programs is outlined below alongside exemplary quotes. Although primarily intended for the development of educational resources by the AWS National Medical Student Committee during the 2020 to 2021 academic year, respondents were informed that the information they provided would also be shared through published AWS Blog posts and this perspective. The organizational quality improvement project was deemed exempt from review by the Yale Institutional Review Board. FIVE MAJOR CONCERNS ABOUT APPLYING TO SURGICAL RESIDENCY DURING COVID-19 Lack of Exposure to Surgical Rotations and Patients  ‘‘I am uncertain how to decide if I want to apply to general surgery or an integrated field given limited exposure during my clerkship. I worry that if I dual-apply, my application to general surgery will be overlooked.’’  ‘‘Coming from a small program, I haven’t been able to return to the OR. I am uncertain if I will be able to touch a patient before I apply.’’ www.annalsofsurgery.com | e85 Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. Annals of Surgery  Volume 273, Number 3, March 2021 Zogg and Stein Delays and Changes in USMLE Exams  ‘‘I am a foreign medical graduate who completed medical school last year. I was supposed to be doing research in the US this year while studying for my exams, but I am still at home. Step 1 and Step 2 CK got rescheduled 9 times over the span of 6 months. Step 2 CS was canceled. I am now being asked to take the Occupational English Test from Australia in its place.’’  ‘‘My medical school is pass-fail during our first 2 years. Clerkships are the only place that we get real grades; those were also change (...truncated)