Surgical training during the COVID-19 pandemic at a designated 'cold' site: are we meeting the challenge?

INTRODUCTION: There has been a marked reduction in surgical operative training opportunities during the COVID-19 pandemic. This may be improved by the establishment of 'cold' sites for NHS elective surgery. We investigated the training opportunities at a newly designated elective surgery cold site in the West Midlands, UK. METHODS: An observational retrospective study was undertaken to include all gastrointestinal and urological elective surgery at a single 'cold' site during the first peak of the COVID-19 pandemic. Patient demographics, details of surgery and data relating to surgical training such as primary surgeon and portfolio index procedure were collected. Factors affecting the likelihood of trainees being the primary surgeon were analysed using logistic regression models. RESULTS: There were 880 patients, with a median (interquartile range) age of 62 (48-74). Some 658 (74.8%) procedures were defined as 'index procedures' for specialty training year 4 (ST4) level: 409/509 (80.4%) for urology, 155/235 (66%) for colorectal and 94/136 (69.1%) for upper gastrointestinal (GI). Only 253/880 (28.8%) procedures were performed by a trainee as the primary surgeon: 201/509 (39.4%) for urology, 21/235 (8.9%) for colorectal and 31/136 (22.8%) for upper GI. The likelihood of a trainee being the primary surgeon was reduced for major surgery (p<0.001) and for GI surgery when compared with urology (p<0.001). CONCLUSIONS: Surgical training was facilitated at an elective surgery 'cold' site during the COVID-19 pandemic, but at lower levels than anticipated. Type of surgery influenced trainee participation. Surgical training should be incorporated into 'cold' site elective surgical services if trainees are to be prepared for the future.

The impact of the COVID-19 pandemic on patients with complex colorectal polyps -a multicentre analysis

Introduction: The COVID-19 pandemic had an adverse impact on endoscopic services. We set out to evaluate the impact on the complex lower gastrointestinal (LGI) polyp services in two NHS hospitals following revised service arrangements based on BSG's guidance. Methods: We analysed 111 patients with complex LGI polyp defined as SMSA score>9(size, morphology, site, access). Demographics, time interval between first (diagnostic) and second (therapeutic) LGI endoscopy, polyp size (including interval growth) and patient outcomes were evaluated. Procedures performed six months after 23-03- 2020 were classed as affected by the COVID-19 outbreak (group-A). While procedures prior to this formed controls (group-B). Kudo pit patterns I,II and IIIL were classed as low risk and IIIs, IV, and V as high risk. Results: 35 patients were in group-A and 76 in group-B with median age of 69 and 71 respectively (P = 0.725), with no statistical gender difference (P = 0.152). Median time interval between LGI procedures was significantly longer in group-A( 16 [IQR 12-20] vs 8 [IQR 5-13] weeks;P = 0.001). Statistically significant (P = 0.031) increase in polyp size was observed in group-A [20 (15-35) to 40 (20-46) mm] as compared to group-B [25 (20-30) to 30 (20-40) mm], without difference in kudo class. Endoscopic resection attempt was abandoned in 5% of patients in group-A as compared to 1% in group-B (P = 0.12).80% of abandoned procedures in group-A required surgical resection. Conclusions: The COVID-19 pandemic has led to a delay in interval LGI endoscopies for patients with complex colonic polyps with a significant increase in size of polyps resulting in patients requiring surgery.

Remote training for combat medics during the COVID-19 era: lessons learnt for future crises?

BACKGROUND: In response to COVID-19, the UK government ordered strict social distancing measures. The UK Armed Forces followed these to protect the force and ensure readiness to respond to various tasking requests. Clinical training has adapted to ensure geographically dispersed medical personnel are trained while social distancing is maintained. This study aimed to evaluate remote training for Combat Medical Technicians, Medical Assistants and Royal Air Force Medics (CMTs/MAs/RAFMs) during the COVID-19 pandemic and the views of trainers on how this should be delivered now and in the future. METHODS: A mixed quantitative and qualitative survey study was conducted to determine the experiences of a sample of Defence Medical Services personnel with remote training during the COVID-19 pandemic. Medical and nursing officers involved in teaching CMTs/MAs/RAFMs were eligible to participate. RESULTS: There were 52 survey respondents. 78% delivered remote training to CMTs/MAs/RAFMs, predominantly using teleconferencing and small-group webinars. 70% of respondents report CMTs/MAs/RAFMs received more training during the COVID-19 pandemic than before. 94% of respondents felt webinar-based remote training should continue after COVID-19. The perceived benefits of webinar-based training included reduced travel time, more training continuity and greater clinical development of learners. CONCLUSIONS: The challenge of continuing education of medical personnel while maintaining readiness for deployment and adhering to the Government's social distancing measures was perceived to have been met within our study sample. This suggests that such an approach, along with clear training objectives and teleconferencing, may enable personnel to deliver high-quality training in an innovative and secure way.