Recovery of Skill Decay After COVID-19 Redeployments and Implications for Competency Attainment.

INTRODUCTION: The COVID-19 pandemic immediately interrupted procedural training. The lasting impact of reduced caseloads and service redeployments on procedural-resident training has been underexplored. This longitudinal study investigated the long-term perspectives of skill decay after short breaks in training and implications for ensuring resident competency attainment. METHODS: Web-based cross-sectional surveys distributed immediately after (June 2020) compared to 1 y after (July 2021) COVID-19 redeployments at two tertiary academic medical centers of an integrated health system in New York. Participants included general surgery, surgical subspecialty, and anesthesiology residents and faculty. RESULTS: Fifty-five residents and 33 faculty completed the survey. Ninety-point nine percent of residents and 36.4% of faculty were redeployed to COVID-ICUs. Sixty-three-point seven percent of residents and 75.0% of faculty reported a reduction in resident technical skills in the short-term, with significantly less (45.5% of residents and 21.2% of faculty) reporting persistent reduction in technical skill after 1 y (P = 0.001, P < 0.001). Seventy-five percent of residents and 100% of faculty were confident residents would be able to practice independently at the conclusion of their training. Sixty-five-point five percent of residents and 63.6% of faculty felt that residents experienced a durable improvement in critical care skills. Residents also reported a positive long-term impact on professional core competencies at 1 y. CONCLUSIONS: Longitudinal surveillance of residents after COVID-19 redeployments suggests washout of temporary skill decay and return of resident confidence upon resumption of traditional training. This may provide insight into the impact of other short-term training interruptions on resident skill and promote greater resident support upon training resumption to ensure competency attainment.

A Survey of the Impact of the COVID-19 Crisis on Skill Decay Among Surgery and Anesthesia Residents.

OBJECTIVE: The SARS-CoV-2 (COVID-19) pandemic has profoundly impacted healthcare delivery and strained medical training. This study explores resident and faculty perceptions regarding the impact of the COVID-19 crisis on technical skill decay of surgical and anesthesia residents. We hypothesized that many residents perceived that their technical abilities diminished due to a short period of interruption in their training. DESIGN: An IRB-exempt, web-based cross-sectional survey distributed to residents and faculty SETTING: Two large academic tertiary medical centers, North Shore University Hospital and Long Island Jewish Medical Center, of the Northwell Health System in New York. PARTICIPANTS: General surgery, anesthesiology, plastic surgery, cardiothoracic surgery, orthopedic surgery, oral maxillofacial surgery, urology, podiatry residents and faculty. RESULTS: All residents reported a significant impact on their training. Residents (82%) and faculty (94%) reported a significant reduction in case volumes due to the COVID-19 pandemic (p < 0.05). 64% of residents reported a reduction in technical skills, and 75% of faculty perceived a decrease in resident technical skills. Residents were concerned about fulfilling ACGME case requirements, however faculty were more optimistic that residents would achieve level-appropriate proficiency by the conclusion of their training. Both residents and faculty felt that resident critical care skills improved as a result of redeployment to COVID-19 intensive care units (66% and 94%). Additionally, residents reported increased confidence in their ability to care for critically ill patients and positive impact on professional competencies. CONCLUSIONS: Effects of the COVID-19 pandemic on residency training are multi-dimensional. The majority of surgical and anesthesia residents perceived that their technical ability diminished as a result of skill decay, whereas other skillsets improved. Longitudinal surveillance of trainees is warranted to evaluate the effect of reduced operative volume and redeployment on professional competency.

Did surgical delay due to COVD-19 affect the short- and longer-term mental health of patients?

At the height of the COVID-19 pandemic, the US Surgeon General ordered the cessation of all elective surgical procedures. We evaluated the mental health impact of COVID-19 related surgical delay on patients awaiting procedures for benign, pre-malignant and malignant conditions. We sought to understand the short term impact of surgical delay and to identify potential longer term mental health affects after completion of the delayed procedure. All patients over age 18 awaiting surgery for benign, pre-malignant or malignant conditions in the gynecologic oncology, surgical oncology and colorectal services at Northwell Health were eligible. Upon enrollment, participants completed a baseline survey consisting of the Generalized Anxiety Disorder Questionnaire (GAD-7), the Penn State Worry Questionnaire (PSWQ), and Brief-Illness Patient Questionnaire (B-IPQ). Six weeks after their surgery, participants were sent a second survey consisting of the Center for Epidemiologic Studies Depression (CES-D) scale in addition to the GAD-7, PSWQ, and B-IPQ. 56 patients underwent their procedure and completed the follow-up survey. Patients with suspected benign conditions had a longer delay in scheduling their surgery than patients with suspected/confirmed cancer or pre-malignant conditions (101.4d vs 66.3d, p<0.05). There was no correlation of length of delay with postoperative worry, anxiety, or depression scores. There was no decrease in level of worry, as delineated by the PSWQ, among gynecologic oncology patients when comparing pre-operative to post-operative data. However, surgical oncology and colorectal patients demonstrated decreased post-operative worry. There was no difference in anxiety by surgical specialty.While the surgical delay was ongoing 79% of patients considered it to be moderately to extremely concerning, with 46% indicating the highest possible level of concern. Post-operatively, 47% of the respondents indicated moderate to extreme concern about the surgical delay, while 37% were not concerned. Initially, the surgical delay was considered to have a moderate to severe impact upon daily life by 65% of patients;which decreased to 53% at the time of post-operative follow-up. Interestingly, these relative decreases in patient concern were not significant when comparing pre-operative to post-operative values as a whole, by diagnosis or by specialty. 20% of participants qualified as depressed based on their response to the CES-D. Of these patients, 70% had a post-operatively confirmed cancer or pre-cancer. The incidence of depression was not affected by the post-operative diagnosis. Many patients experienced distress surrounding surgical delay due to the COVID-19 pandemic. This extended to their postoperative period. Gynecologic oncology patients did not experience decreased post-operative worry, while surgical oncology and colorectal patients did. There was no significant difference in the incidence of post-operative depression by specialty or post-operative diagnosis. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)