Below are three findings informed by our theoretical framework of Small and Adler: 1) The deterring formation of personal social ties in early experiences; 2) the promotion of a sense of community bonding during middle and later periods; and 3) the limited access to the formation of professional social ties throughout the duration.
Deterring formation of personal social ties
The lack of social ties was most salient during the early period of data collection when social distancing measures were strict. Averil indicated during the early period, “I think everyone or at least a lot of people were really trying to make connections. Then some people in our class got Covid and so everything had to go online in November.” As this participant described, the challenges of developing social ties intensified after COVID began to spread among her peers and classroom spaces closed.
Some students opted to “go home” to their families or their pre-existing social networks to find support rather than be alone without new social ties in medical school. Averil again shared, “people were going home, and I don’t blame them. A lot of people would rather be home than be alone in their apartment.” However not all participants could go home, or take advantage of family’s spatial propinquity for support. Trish, who did not go home because she was out of state and her family was in California, described some of the awkwardness of trying to form new social ties, “I’m thankful I’ve made some friends, but it still feels like ‘do you want to go out and have a separate picnic together?’” This participant indicated she was thankful to have formed some ties and connections, however there were limitations in the spatial composition and few gathering spaces where students could be together without also feeling “separate.”
At the end of year 1, the same participant, Trish, who stayed on campus shared, “Certain people have thrived in the sense that they can still do things virtually. Some of my classmates will be texting in our little group, and sure I love that they’re able to do that. But I’m not able to just have those casual relationships and ability to ask for help.” This participant hinted at the challenges to forming “casual” relationships over text or virtually, potentially due to the ways the spatial configuration of the pandemic shaped emotions and psychological barriers to being online. Perhaps more importantly, this participant identified some forms of social isolation by mentioning it was difficult to also ask for help, thereby limiting her ability to find support personally.
The challenge in forming personal social ties was also tightly connected to participants’ ability to feel academically motivated. Many participants described how friendships aided their study habits, and the lack of social ties deterred or made difficult the academic mindset. Delia, at the end of her first year, described it thus:
COVID has made it more stressful because I'm just home. I'm not seeing my friends. I feel like I get motivated when I see other people around me, like studying and going out to groups to study, but it hasn’t been happening. And I'm just me alone at home.
Even at the end of year two, Dora shared, “It has been challenging to form connections in a COVID world.” The impact of COVID on forming personal social ties was not limited to the early months of the pandemic. Rather, some participants identified their first two-years as learning in a COVID world, which entailed constraints on being able to physically connect and the challenges of being isolated with few, close proximal connections.
Promoting a sense of community bonding
Over the two-year period of this LQR, many participants noted how the shared experience of the pandemic facilitated community bonding. This was most evident during the middle period and end period of data collection, when social distancing measures eased and students had a chance to get to know one another. Missy commented near the end of the data gathering time period, “We’ve bonded over the craziness that COVID caused.” Another participant, Emily, shared during the middle period,
It’s basically grad school during COVID. I didn’t expect to really make that many friends. I feel like I’ve been proven wrong by how welcoming and open everyone is. It’s been helpful in managing all the craziness that’s happening, these solid group of friends, they understand and they’re going through it with you.
Emily reiterated this closeness in the later time period: “The struggles and challenges of COVID specifically have brought us so much closer together as a class, as a group.” Anna shared, “it’s [COVID] is something that we all kind of get to vent about and I feel like we’ve made an effort to kind of get together and support each other, particularly the women.” This comment specifies how COVID and its barrier to forming social ties also created a bonding moment especially for women, particularly through the mental and emotional experience of the pandemic. By describing their shared “struggles and challenges” and ways they “bonded over the craziness that COVID caused” participants pointed to the spatial configuration, or the emotional and psychological pathway to forming ties, that the pandemic ironically created.
Moments of bonding and shared experience, however, did not always result in connection. Although some participants found a sense of common-ground with others through shared mental and emotional experiences, the physical distance and potentail for gathering spaces (spatial composition) remained ambiguous. One participant expounded on not being able to be near others, mentally feeling isolated without witnessing or communicating the “norms” of medical school studying. Delia shared, “I don't have a standard [for what to do] like, is everybody doing this? Then I have to do this. But I don't know what everybody's doing. I don't know what I should be doing.” Delia discussed the tension in not knowing what others were “doing”, yet also considered there may be some shared experiences of “not knowing what to do.” The physical distances and lack of social spaces to gather and connect manifest in some uncertaintity for participants, leading them to question if what they were feeling emotionally might be similar to others’ experiences. Some questioned whether their own study habits or learning practices were an accurate way of “doing” medical school.
Others felt a lack of bonding in personal experiences that could have been beneficial. Rianna confided during the middle period, “Maybe it’s because I live out here in a small town, a little bit away from everybody else. Maybe it’s because I didn’t go to parties while COVID was happening. I don’t know. Somewhere I missed the boat and everybody became really good friends.” After having seen her classmates form friendships, Rianna wondered whether her physical distance, or spatial propinquity, and unwillingness to attend parties in the midst of COVID was perhaps what made it difficult for her to establish social ties. Thus, the interaction of spatial configuration (psychological barriers to gathering) with her spatial propinquity (physical distance) and spatial composition (few safe gathering spaces) inhibited her ability to form personal social ties in the preclinical phase.
Limiting access to the formation of professional ties
Throughout the two-year period, participants lamented the difficulty in forming ties with faculty and other professionals in the field. Eliza stated during the middle period, “Where it suffers is forming professional relationships. I think that’s been a little bit harder to do because of the lack of shadowing and lack of exposure; it’s hard after a year of zoom classes.” Early in medical school, Hannah shared “I get discouraged about being the kind of doctor I want to be when I go for longer periods of time without interaction. Video conference calls and isolated learning is very difficult for me.” Nearing the end period, another participant, Kate expressed the same sentiment: “It’s hard. I didn’t connect with faculty, because you’re on zoom in a 100-200-person class. You can’t stay after. Can’t ask a question. It’s not like, ‘oh hey, I’m so and so, I’m the girl with the light grey couch and it looks kind of sticky.”
Many participants shared their concern near the end of their two-years in not forming relationships with faculty. During the last interview of year two, Sophie shared,
It comes down to the lack of shadowing and lack of exposure. In terms of specialty that’s my biggest stressor right now, picking a specialty I’m going to be happy in. Pretty big life decision. And depending on what specialty I’m going to have I need to really be prepping for this life decision. Because like, anesthesiology? Like where am I going to get exposed to anesthesiology? Or critical care? When am I going to see it? I have relationships with faculty, but for certain specialties they really want letters from someone in the field and that’s daunting for someone like me.
This participant was explicit about naming “someone like me” when she described how daunting it was to find a mentor or faculty member during the time of medical school closures. As a young woman medical student of color, Sophie was aware of the difficulties she would face. On top of that was the compounding difficulty given the psychological barriers in spatial configuration of the pandemic. In contrast, Marcy shared this at the end of her second year, “I didn’t have the advantage of having physician parents, which seems like a very key part of the hidden curriculum…and with COVID and everything it’s been hard. But I have been able to establish myself with some faculty a little bit more.” Although she indicated the challenges during the height of COVID in forming relationships combined with not having access to the “hidden curriculum” others with physician parents had, she did find ways to establish some faculty relationships.
The impact of COVID-19 on forming professional social ties highlighted how some participants struggled to challenge themselves in new ways in medical school. Near the end of her first-year, Hannah shared a little about herself and in doing so, described the complexities of her experiences with the pandemic:
Being more introverted and anxious has allowed me to stay in my comfort zone. As much as it has been good for my mental health, in a way that I can avoid my anxieties, in my day-to-day life, I also know I am not pushing myself to be better. I am not getting to form relationships with my professors or look to find a mentor.
This participant ruminated how she was able to take care of herself and her mental health through the isolation that COVID-19 brought. However, she was also cognizant about the “comfort zone” she was staying in, and how her disposition (being introverted and feeling anxious) could also limit her ability to make connections with faculty were she unwilling to push herself. Under the cover of the pandemic, this participant would lean into the spatial configuration of the emotional and psychological barriers of connecting. As the spatial composition shifted, with it came increased access to shared learning and gathering spaces. Eventually, the spatial propinquity evolved to invite increased proximity between participants could provide opportunities to form, yet some still struggled to overcome other challenges to forming potentially valuable professional ties due to lack of exposure (Sophie) or being able to use the pandemic to nestle into their own comfort zones of staying in (Hannah).