COVID Faces: Unmasking the Emotional Impact of the Pandemic

Abstract

Background:  In April 2020, most undergraduate medical education programs across the country ceased in-person activities.  In the months that followed, the return to clinical care was often inconsistent, sporadic and unpredictable.  As the pandemic wore on, the impact of COVID-19 on professional identity formation in medical students was an area ripe for investigation. This study reveals student perceptions of the impact of COVID-19 on their developing sense of professional identity. Methods: Students in the Class of 2021 at the Pennsylvania State University College of Medicine were invited to participate. After approval from the Institutional Review Board, participating students submitted an image of themselves wearing a mask of their choosing ("selfie") with an accompanying reflective narrative describing the impact of the pandemic on their educational experience.  In addition, students submitted words to describe the self they projected (external) on the outside of a templated surgical mask and words to describe their true (internal) sense of self on the inside of the mask. Results: Common narrative themes that emerged included doubt, anxiety, fear, disconnection, loss of control, guilt, sacrifice, resilience and survival.  Analysis of descriptors of internal and external aspects of the templated surgical masks revealed common themes of anxiety, fear, confusion and hope. Conclusions: This study provides a glimpse into the student experience of COVID-19 through several lenses.  From the narrative perspective, students expressed elements of disconnection and doubt as well as resilience and grit. From the visual perspective, similar themes emerged from the mask descriptors.  Overall, COVID-19 significantly impacted the emotional experiences of this cohort of fourth-year medical students, particularly in the context of sustained uncertainty and feelings of anxiety.