COVID-19 and the impact on surgical training and education in Singapore

Objective The COVID-19 pandemic has had a significant impact on patient care, including the increased utilization of contact-free clinic visits using telemedicine. We looked to assess current utilization of, experience with, and opinions regarding telemedicine by general surgery residents at an academic university–based surgical training program. Design A response-anonymous 19-question survey was electronically distributed to all general surgery residents at a single academic university–based general surgery residency program. Setting University of Southern California (USC) general surgery residency participants: Voluntarily participating general surgery residents at the University of Southern California. Results The response rate from USC general surgery residents was 100%. A majority of residents (76%) had utilized either video- or telephone-based visits during their careers. No resident had undergone formal training to provide telemedicine, although most residents indicated a desire for training (57.1%) and acknowledged that telemedicine should be a part of surgical training (75.6%). A wide variety of opinions regarding the educational experience of residents participating in telemedicine visits was elicited. Conclusions The COVID-19 pandemic brought telemedicine to the forefront as an integral part of future patient care, including for surgical patients. Additional investigations into nationwide telemedicine exposure and practice among United States general surgery residencies is imperative, and the impact of the implementation of telemedicine curricula on general surgery resident telemedicine utilization, comfort with telemedicine technology, and patient outcomes are further warranted. Competencies Practice-based learning, systems-based practice, interpersonal and communication skills

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Riding the waves: the ongoing impact of COVID-19 on a national surgical training cohort

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02739-4 ◽

2021 ◽

Author(s):

Orla Hennessy ◽

Amy Lee Fowler ◽

Conor Hennessy ◽

David Brinkman ◽

Aisling Hogan ◽

...

Keyword(s):

Surgical Training ◽

World Health Organisation ◽

World Health ◽

Training Methods ◽

Viral Spread ◽

Surgical Services ◽

Global Pandemic ◽

Surgical Trainees ◽

Secondary Survey ◽

The Impact

Abstract Background The World Health Organisation declared a global pandemic on the 11 March 2020 resulting in implementation of methods to contain viral spread, including curtailment of all elective and non-emergent interventions. Many institutions have experienced changes in rostering practices and redeployment of trainees to non-surgical services. Examinations, study days, courses, and conferences have been cancelled. These changes have the potential to significantly impact the education and training of surgical trainees. Aim To investigate the impact of the COVID-19 pandemic on training, educational, and operative experiences of Irish surgical trainees. Methods Surgical trainees were surveyed anonymously regarding changes in working and educational practices since the declaration of the COVID-19 pandemic on 11 March 2020. The survey was circulated in May 2020 to both core and higher RCSI surgical trainees, when restrictions were at level five. Questions included previous and current access to operative sessions as well as operative cases, previous and current educational activities, access to senior-led training, and access to simulation-/practical-based training methods. A repeat survey was carried out in October 2020 when restrictions were at level two. Results Overall, primary and secondary survey response rates were 29% (n = 98/340) and 19.1% (n = 65/340), respectively. At the time of circulation of the second survey, the number of operative sessions attended and cases performed had significantly improved to numbers experienced pre-pandemic (p < 0.0001). Exposure to formal teaching and education sessions returned to pre-COVID levels (p < 0.0001). Initially, 23% of trainees had an examination cancelled; 53% of these trainees have subsequently sat these examinations. Of note 27.7% had courses cancelled, and 97% of these had not been rescheduled. Conclusion Surgical training and education have been significantly impacted in light of COVID-19. This is likely to continue to fluctuate in line with subsequent waves. Significant efforts have to be made to enable trainees to meet educational and operative targets.

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The Impact of COVID-19 on Surgical Training: the Past, the Present and the Future

Indian Journal of Surgery ◽

10.1007/s12262-021-02964-2 ◽

2021 ◽

Author(s):

Marina Yiasemidou

Keyword(s):

Infection Control ◽

Surgical Training ◽

New Technologies ◽

Negative Impact ◽

Elective Surgery ◽

Control Measures ◽

Negative Consequences ◽

Surgical Services ◽

The World ◽

The Impact

AbstractThe COVID-19 pandemic and infection control measures had an unavoidable impact on surgical services. During the first wave of the pandemic, elective surgery, endoscopy, and ‘face-to-face’ clinics were discontinued after recommendations from professional bodies. In addition, training courses, examinations, conferences, and training rotations were postponed or cancelled. Inadvertently, infection control and prevention measures, both within and outside hospitals, have caused a significant negative impact on training. At the same time, they have given space to new technologies, like telemedicine and platforms for webinars, to blossom. While the recovery phase is well underway in some parts of the world, most surgical services are not operating at full capacity. Unfortunately, some countries are still battling a second or third wave of the pandemic with severely negative consequences on surgical services. Several studies have looked into the impact of COVID-19 on surgical training. Here, an objective overview of studies from different parts of the world is presented. Also, evidence-based solutions are suggested for future surgical training interventions.

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The Impact of the COVID-19 Pandemic on Head and Neck Surgery Training: A Brazilian National Survey

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1730019 ◽

2021 ◽

Author(s):

Ana Kober Leite ◽

Leandro Luongo Matos ◽

Claudio R. Cernea ◽

Luiz Paulo Kowalski

Keyword(s):

Head And Neck ◽

Surgical Training ◽

Online Survey ◽

Negative Impact ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Educational Activities ◽

Residency Programs ◽

Surgery Training ◽

The Impact

Abstract Introduction The COVID-19 pandemic has had a high impact on surgical training around the world due to required measures regarding the suspension of elective procedures and the dismissal of nonessential personnel. Objectives To understand the impact the pandemic had on head and neck surgery training in Brazil. Methods We conducted a 29-question online survey with head and neck surgery residents in Brazil, assessing the impact the pandemic had on their training. Results Forty-six residents responded to the survey, and 91.3% of them reported that their residency was affected by the pandemic, but most residents were not assigned to work directly with patients infected with the new coronavirus (71.4%). All residents reported decrease in clinic visits and in surgical procedures, mostly an important reduction of ∼ 75%. A total of 56.5% of the residents described that the pandemic has had a negative impact on their mental, health and only 4 (8.7%) do not have any symptoms of burnout. The majority (78.3%) of the residents reported that educational activities were successfully adapted to online platforms, and 37% were personally infected with the virus. Conclusion Most surgical residencies were greatly affected by the pandemic, and residents had an important decrease in surgical training. Educational activities were successfully adapted to online modalities, but the residency programs should search for ways of trying to compensate for the loss of practical activities.

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Blood, Sweat, Toil, and Tears of Surgical Training. Part I: Blood

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230701500408 ◽

2007 ◽

Vol 15 (4) ◽

pp. 307-309 ◽

Cited By ~ 2

Author(s):

Andrew J Drain ◽

Jonathon I Ferguson ◽

Sharon Wilkinson ◽

Samer AM Nashef

Keyword(s):

Adverse Effect ◽

Blood Loss ◽

Operating Room ◽

Clinical Outcomes ◽

Surgical Training ◽

Clinical Service ◽

Significant Difference ◽

Potential Impact ◽

The Impact ◽

Cardiac Operations

There may be conflict between the requirements of surgical training and those of the clinical service if training has an impact on clinical outcomes. One area of potential impact is perioperative blood loss. We compared total and 12-hour blood loss after 2,079 consecutive cardiac operations performed over 2 years by trainees and consultants. One- and two-way analyses of variance with EuroSCORE and surgeon status as factors were carried out to evaluate the impact of surgeon status on blood loss. There was no difference in blood loss between consultants and trainees. We also compared the rates between consultants and trainees of patients returning to the operating room due to bleeding. This showed a significant difference, with trainees having a higher rate of investigation for bleeding. Cardiac surgical training can be achieved without an adverse effect on blood loss, but it may be associated with a higher rate of re-intervention for bleeding.

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CHANGING PRESCRIBING CULTURE – A FOCUS ON CODEINE POSTPARTUM

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311535.2 ◽

2016 ◽

Vol 101 (9) ◽

pp. e2.12-e2 ◽

Cited By ~ 2

Author(s):

Noor Al-Adhami ◽

Karen Whitfield ◽

Angela North

Keyword(s):

Breast Feeding ◽

Medical Staff ◽

Successful Outcome ◽

Postpartum Women ◽

Limited Data ◽

Training And Education ◽

Key Stakeholders ◽

Postpartum Analgesia ◽

The Impact ◽

Breast Fed

AimTo eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1 MethodsThe evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff.ResultsThe evidence that was presented to key stakeholders included:▸ Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding▸ Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).▸ Recommendations from the Australian Medicines Handbook to avoid in breast feeding2 ▸ Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data–probably compatible) to L4 (limited data–possibly hazardous).3 Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their ‘as required’ analgesic regimen.Since the intervention, codeine combination products have now been almost completely eliminated on medication charts for postpartum women (less than 5%). Those that are prescribed are ceased once highlighted to medical staff. The obstetric pharmacist now presents a session on postpartum analgesia at every new resident medical officer orientation outlining suitable medications to prescribe. In addition all new pharmacists to the women's and new born's team receive training about postpartum analgesia.ConclusionThis study highlights the impact that can be achieved when health care professionals work together to change the culture and prescribing habits in a hospital setting, to enhance patient safety. Evaluating the evidence and presenting to stakeholders as well as providing ongoing training and education to medical, nursing and pharmacy staff are all essential to a successful outcome.

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The impact of the DM surgical training programme on the practice of surgery in the English-speaking Caribbean

West Indian Medical Journal ◽

10.1590/s0043-31442006000100014 ◽

2006 ◽

Vol 55 (1) ◽

Cited By ~ 3

Author(s):

LK Simpson

Keyword(s):

Surgical Training ◽

Training Programme ◽

English Speaking ◽

The Impact

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982 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab259.884 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Khan ◽

G Torpiano ◽

N Galbraith ◽

M McLellan ◽

A Lannigan

Keyword(s):

Surgical Training ◽

Annual Review ◽

Surgical Trainee ◽

Training Groups ◽

Surgical Trainees ◽

The Impact

Abstract Aim The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades. Method All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared. Results Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276). Conclusions The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.

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Impact of the COVID-19 pandemic on core surgical training

Scottish Medical Journal ◽

10.1177/0036933020949217 ◽

2020 ◽

Vol 65 (4) ◽

pp. 133-137 ◽

Cited By ~ 1

Author(s):

Khurram Shahzad Khan ◽

Rona Keay ◽

Morag McLellan ◽

Sajid Mahmud

Keyword(s):

Surgical Training ◽

Teaching Hospital ◽

General Surgery ◽

Negative Impact ◽

Outpatient Clinics ◽

Box Trainer ◽

Surgical Trainees ◽

Long Term Impact ◽

The Impact

Background and aims COVID-19 pandemic has caused significant disruption in training which is even more pronounced in the surgical specialties. We aim to assess the impact of COVID-19 pandemic on core surgical training. Methods All core surgical and improving surgical trainees in West of Scotland region were invited to participate in an online voluntary anonymous survey via SurveyMonkey. Results 28 of 44 (63.6%) trainees responded, 15 (53.6%) were CT1/ST1. 14 (50.0%) working in teaching hospital and 15 (53.6%) working in general surgery. 20 (71.4%) felt that due to the pandemic they have less opportunity to operate as the primary surgeon. 21 (75.0%) have not attended any outpatient clinics. 8 (28.6%) did not have any form of access to the laparoscopic box-trainer. 20 (71.4%) felt their level of confidence in preforming surgical skills has been negatively impacted. 18 (64.3%) found it difficult to demonstrate progress in portfolio. 21 (75.0%) trainees have not attended any teaching. 10 (35.7%) trainees have been off-sick. 8 (28.6%) trainees have felt slightly or significantly more stressed. Conclusion COVID-19 pandemic has an unprecedented negative impact on all aspects of core surgical training. The long term impact on the current cohort of trainees is yet to be seen.

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