The Virtual Face of Colon and Rectal Surgery Training in the USA: An In-Depth Evaluation and Analysis of Fellowship Programs Website Content.

BACKGROUND: With an ever-evolving digital and virtual world hastened by the COVID-19 pandemic, prospective colon and rectal surgery fellowship applicants must rely on online sources of information, such as websites, rather than in-person visits to fellowship programs. This study analyzes and evaluates the content and accuracy of colon and rectal surgery fellowship program websites. METHODS: The Fellowship and Residency Electronic and Interactive Database website provides a complete collection of colon and rectal surgery fellowship websites based in the USA. The accessibility of the websites was verified via Google search, and relevant content for the applicants was evaluated based on 50-point criteria. RESULTS: Analysis of 60 fellowship program websites was conducted, out of which only a fifth (20%) were kept up to date. Twenty-seven (45%) websites fulfilled 50% of the 50-point criteria. The most and least included data points were program overview (69%) and residential/housing information (24%). Most websites contained basic information relevant to international applicants but lacked crucial information such as visa sponsorship (12%) and city information (23%). CONCLUSION: An informative and easily accessible website is essential for prospective applicants to choose the best program for their career goals and academic needs. This study highlighted multiple areas for potential improvement in the colon and rectal surgery program websites. Individual colon and rectal surgery programs may benefit and attract more candidates to their programs through a fully optimized website design and content.

Adaptations to general surgery resident education in response to COVID-19.

BACKGROUND: The COVID-19 pandemic led to many new provincial public health measures to reallocate resources in response to an impending surge of cases. These necessary decisions had several downstream effects on general surgery training. We surveyed the actions taken by Canadian general surgery training programs in response to the COVID-19 pandemic. METHOD: A mixed-methods survey was sent to all general surgery program directors to assess various domains in surgical education and modifications made because of the pandemic. Responses were quantified as proportions or qualitative narratives describing those changes. RESULTS: Most programs (13/15) recalled residents from planned rotations and redistributed them to rotations considered as core required services, including acute care surgery, trauma surgery and intensive care. Many programs also restructured their acute care surgery models to allow for a group of "reserve" residents to replace trainees who became infected with SARS-CoV-2. In terms of clinical experience, there was a reduction in both clinical and operative exposure among trainees. The reduction in clinical exposure disproportionately affected junior residents, whose involvement in COVID-19 cases was restricted. Formal educational sessions were maintained, but delivered virtually. Many programs instituted a program of increased frequency of communication with trainees. CONCLUSION: Many programs embraced using virtual platforms for teaching. The demonstrated utility of virtual teaching may lead to rethinking how training programs deliver didactic teaching and expand teaching opportunities. However, many programs also perceived a decrease in clinical and procedural exposure, primarily affecting junior residents. More information is needed to quantify the deficit in learning incurred as a result of the pandemic as well as its long-term effects on resident competency.

Measuring the impact of delayed access to elective cholecystectomy through patient's cost-utility: an observational cohort study.

BACKGROUND: Deferral of surgeries due to COVID-19 has negatively affected access to elective surgery and may have deleterious consequences for patient's health. Delays in access to elective surgery are not uniform in their impact on patients with different attributes. The objective of this study is to measure the change in patient's cost utility due to delayed elective cholecystectomy. METHODS: This study is based on retrospective analysis of a longitudinal sample of participants who have had elective cholecystectomy and completed the EQ-5D(3L) measuring health status preoperatively and postoperatively. Emergent cases were excluded. Patients younger than 19 years of age, unable to communicate in English or residing in a long-term care facility were ineligible. Quality-adjusted life years attributable to cholecystectomy were calculated by comparing health state utility values between the pre- and postoperative time points. The loss in quality-adjusted life years due to delayed access was calculated under four assumed scenarios regarding the length of the delay. The mean cost per quality-adjusted life years are shown for the overall sample and by sex and age categories. RESULTS: Among the 646 eligible patients, 30.1% of participants (N = 195) completed their preoperative and postoperative EQ-5D(3L). A delay of 12 months resulted in a mean loss of 6.4%, or 0.117, of the quality-adjusted life years expected without the delay. Among patients older than 70 years of age, a 12-month delay in their surgery corresponded with a 25.1% increase in the cost per quality-adjusted life years, from $10 758 to $13 463. CONCLUSIONS: There is a need to focus on minimizing loss of quality of life for patients affected by delayed surgeries. Faced with equal delayed access to elective surgery, triage may need to prioritize older patients to maximize their health over their remaining life years.

Optimizing Resident Wellness During a Pandemic: University of British Columbia's General Surgery Program's COVID-19 Experience.

OBJECTIVE: The University of British Columbia's General Surgery Program delineates a unique and systematic approach to wellness for surgical residents during a pandemic. SUMMARY BACKGROUND DATA: During the COVID-19 pandemic, health care workers are suffering from increased rates of mental health disturbances. Residents' duty obligations put them at increased physical and mental health risk. It is only by prioritizing their well-being that we can better serve the patients and prepare for a surge. Therefore, it is imperative that measures are put in place to protect them. METHODS: Resident wellness was optimized by targeting 3 domains: efficiency of practice, culture of wellness and personal resilience. RESULTS: Efficiency in delivering information and patient care minimizes additional stress to residents that is caused by the pandemic. By having a reserve team, prioritizing the safety of residents and taking burnout seriously, the culture of wellness and sense of community in our program are emphasized. All of the residents' personal resilience was further optimized by the regular and mandatory measures put in place by the program. CONCLUSIONS: The new challenges brought on by a pandemic puts increased pressure on residents. Measures must be put in place to protect resident from the increased physical and mental health stress in order to best serve patients during this difficult time.

Surgical training in the midst of a pandemic: a distributed general surgery residency program's response to COVID-19.

Summary: The coronavirus disease 2019 (COVID-19) pandemic has had a substantial impact on surgical training. We describe some of the challenges brought on by the pandemic and our program's province-wide response to them. We focus specifically on residents' provision of service, education and wellness.