From the Journals

Pandemic’s impact on surgical training is lessening, but trainees’ mental health still at risk


NEW YORK (Reuters Health) – Compared to Spring 2020, by Summer 2021 surgical education and training were less negatively impacted by the pandemic, although disruption of emotional well-being remained high, survey results showed.

In March 2020, a committee appointed by the American College of Surgeons to study the impact on the COVID-19 pandemic on surgical education and training sent a 37-item survey to 2,196 surgical education leaders in the United States and Canada. Based on responses from 472 (21%), nationwide lockdowns were associated with severe disruption of educational programs, non-emergency surgical volume and trainee well-being (due to lack of personal protective equipment, fear, stress, and isolation).

A year later, the committee sent out a 46-item survey to 2,245 general surgery and surgical specialty education leaders, 372 of whom (17%) responded. As reported in the Journal of the American College of Surgeons, in 2021, severe disruption of education programs was reported by 14%, compared to 32% in 2020 (p<.0001). Severe disruption of non-emergency surgery was reported by 38%, compared to 87% the year before.

Proportions of responses in 2021 reporting major or severe disruption were 1% for emergency surgery, 26% for outpatient clinic, 18% for essential external rotations and 28% for non-essential external rotations. Proportions reporting major or full recovery in 2021 were 82% for non-emergency surgery, 94% for emergency surgery, 82% for outpatient clinic, 82% for essential external rotations, and 74% for non-essential external rotations.

The pandemic’s impact on ability to achieve minimum case numbers by level of training was lighter at the time of the second survey, with a lower proportion reporting major or severe impact in 2021 vs 2020: 8% vs 30% for fellows (p<.0001), 9% vs 31% for PGY 5 (p<0.0001), 11% vs 44% for PGY 3-4 (p<0.0001), and 8% vs 24% for PGY 1-2 (p<0.0001).

The impact on the expected progression to operative autonomy was reportedly major or severe in 5% of fellows in 2021 compared to 16% in 2020 (p=0.001), 7% of PGY 5 vs 14 % in 2020 (p=0.003), 7% of PGY 3-4 vs 16% in 2020 (p=0.0008) and 8% in PGY 1-2 vs 24% in 2020 (p<.0001).

The respondents indicated, however, that certain core competencies needed additional interventions during subsequent training, including technical skills (72%), medical knowledge (32%), problem solving (25%), communication skills (23%) and professionalism (18%). “Clinical remediation” efforts for PGY 1-2 and PGY 3-4 included revised rotations (19% and 26%) and additional use of simulation (20% and 19%).

Delayed graduation or promotion was reported by less than 2% of respondents, however. Nor was there an effect on fellowship or job placements.

While trainees’ physical safety and health were reported as less severely impacted compared to 2020; negative effects of isolation (77%), burnout (75%) and severe impact on emotional well-being (17%) were prevalent.

The researchers note that given the ongoing pandemic, there is potential for further disruption of surgical volume and that “it is imperative that education leaders in each surgical specialty work diligently to define alternative strategies including improved measures of surgical competence beyond case numbers.”

They also noted that telehealth presents new opportunities for surgical education and is presently underutilized.

Finally, they conclude, “The negative impact of the pandemic on trainee emotional well-being persists... Collaborative efforts in graduate medical education are encouraged in order to define best practices to promote surgical trainee emotional wellbeing and to develop evidence-based solutions that can be implemented at individual sponsoring institutions.”

Reuters Health Information © 2022

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