Visualising surgical training in O&G following the COVID-19 pandemic - The European view.

Background & Objectives: Obstetrics and Gynaecology (O&G) training programmes that traditionally relied on the hands-on apprenticeship-training model, became crippled with the global response to the COVID-19 pandemic. Methods: Web-based anonymised survey was circulated to trainee members of the European Society for Gynaecological Endoscopy (ESGE) over 8-weeks period commencing June 2021. Results: 213 trainees from 20 countries responded. Trainees from medium Human Development Index (HDI) countries were less represented. 78% (166/213) were in approved training programmes and 81% (174/213) had access to personal PPE. The vaccine uptake was 87% (185/213). 39% (89/213) and 55% (118/213) experienced negative impact on their physical and mental wellbeing with 36% (76/213) COVID-19 related absence. 15% (32/213) were redeployed to areas outside O&G. 25% (53 /213) had negative impact on their obstetric experience compared to 54% (114/213) reported lower gynaecology surgical exposure and 43% (91/213) failed to meet their gynaecology surgical competencies during the pandemic. 64% (137/213) perceived simulation training as an alternative training tool. Conclusion: In the post-pandemic recovery phase, gynaecological societies and national institutes across Europe continue to develop training curricula implementing virtual and hybrid training modules. The aim is to develop a robust blueprint to safeguard the gynaecological surgical training in the future. What is new?: The ongoing impact on the training in the post pandemic era remains to be evaluated. Our pan Europe survey highlights areas that remain affected from trainees' perspective and assesses differences in the healthcare systems across continent. We then discuss the novel initiatives taken to overcome training gaps.

The impact of COVID-19 on O&G trainees; where are we now?

Background and Objectives: Obstetrics and Gynaecology (O&G) training continues to face challenges caused by the COVID-19 pandemic, particularly in gynaecological surgical training. This follow-up survey captures the ongoing effect on O&G trainees and highlights the future recovery plan considering the historical training gaps in benign gynaecology. Materials and Methods: an anonymised survey was emailed to all O&G trainees in Kent, Surrey and Sussex (KSS). Responses were collected over 6 weeks. Main Outcome Measures and Results: 53% of trainees responded. In total, 78% of trainees agreed that the pandemic had an ongoing negative effect on their physical and mental wellbeing respectively. Trainees felt the prior negative impact on obstetric training is improving, whilst 88% still experience a negative impact on their gynaecology surgical training despite the resumption of elective services in the National Health Service (NHS). 80% continue to feel the negative impact on their educational activities and 88% felt their overall training continues to be negatively impacted. 70% were positive that they would recover from this. Responses were representative of each training year. Interestingly, 95% of trainees had accepted the COVID vaccine. Conclusion: despite "restoration" of normal services, the negative impact on trainees particularly benign gynaecology surgical training continues. Addressing pre-pandemic training gaps whilst tackling the surgical back-log and the needs of service provision will continue for years to follow. What is new?: Future training needs to incorporate creative ways of acquiring surgical skills. It is imperative to imbed simulation training into O&G training programmes. Pastoral support is key to ensure trainees' mental and physical well-being are prioritised and the already high burn-out rates do not worsen.

Impact of severe acute respiratory syndrome coronavirus 2 on ectopic pregnancy management in the United Kingdom: a multicentre observational study.

OBJECTIVE: To describe the impact of coronavirus disease 2019 (COVID-19) on the management of women with ectopic pregnancy. DESIGN: A multicentre observational study comparing outcomes from a prospective cohort during the pandemic [COVID-19-ectopic pregnancy registry (CEPR)] compared with a historical pre-pandemic cohort [non-COVID-19-ectopic pregnancy registry (NCEPR)]. SETTING: Five London university hospitals. POPULATION AND METHODS: Consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March 2020-August 2020) were entered into the CEPR and results were compared with the NCEPR cohort (January 2019-June 2019). An adjusted analysis was performed for potentially confounding variables. MAIN OUTCOME MEASURES: Patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non-surgical management), length of stay (surgical management) and 30-day complications. RESULTS: Three hundred and forty-one women met the inclusion criteria: 162 CEPR and 179 NCEPR. A significantly lower percentage of women underwent surgical management versus non-surgical management in the CEPR versus NCEPR (58.6%; 95/162 versus 72.6%; 130/179; P = 0.007). Among patients managed with expectant management, the CEPR had a significantly lower mean number of hospital visits compared with NCEPR (3.0, interquartile range [IQR] [3, 5] versus 9.0, [5, 14]; P = <0.001). Among patients managed with medical management, the CEPR had a significantly lower median number of hospital visits versus NCEPR (6.0, [5, 8] versus 9, [6, 10]; P = 0.003). There was no observed difference in complication rates between cohorts. CONCLUSION: Women were found to undergo significantly higher rates of non-surgical management during the COVID-19 first wave compared with a pre-pandemic cohort. Women managed non-surgically in the CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complication rates. TWEETABLE ABSTRACT: A higher rate of non-surgical management of ectopic pregnancy during the COVID-19 pandemic did not increase complication rates.

Intracorporeal laparoscopic suturing training: Computers versus the instructor

Objective Our recent experience suggests that current and future generations of surgical trainees will have less opportunity for traditional face to face surgical and to an extension laparoscopic simulation training because of social distancing and limitations in travelling due to prolonged Covid-19 restrictions. Design We designed a computer-based video instruction (CBVI) package to test the training potential (primary outcome) and effectiveness (secondary outcome) of CBVI when compared to the traditional instructor-guided simulation training (IGST) for intracorporeal laparoscopic suturing. Method Twenty 3rd and 4th year medical students from Barts Medical School;who had no previous laparoscopic experience, volunteered to attend a 60-min training session followed by a performance assessment at the end of their session and after 4 weeks. They were randomized in two groups of 10 participants. The groups were matched for gender, right/left hand dominance, previous knowledge of a musical instrument and/or video games exposure and surgical career aspirations. Results Both groups showed similar performance outcomes for task completion, an intracorporeal laparoscopic knot, confirming our primary outcome that CBVI has comparable training potential. Nine out of 10 participants of the CBVI group successfully completed the task, with only one dropout;while in the IGST group only 7 out of 10 participants successfully completed the task with three dropouts. (P = 0.267). Regarding the secondary outcomes (time and precision), both CBVI and IGST groups had similar performance without substantial difference for all three key steps of laparoscopic suturing (needle loading, needle driving, knot tying). On the 4-week skills retention assessment individuals of the CBVI group performed significantly better compared to the IGST for needle loading (F = 9.758, P = .014). Conclusion CBVI participants completed the task and showed lower time in needle loading than their IGST counterparts, therefore supporting the hypothesis that CBVI training for laparoscopic intracorporeal suturing seems to be reliable and effective. Moreover, when we take into account costs for travelling and hiring of training facilities as well as considerable faculty time commitments, which can also result to clinical time scheduling conflicts, then the video-only training is a more effective training approach for laparoscopic suturing and potentially other complex laparoscopic skills training;especially during Covid-19 restrictions.

The impact of COVID-19 on obstetrics and gynaecology trainees; how do we move on?

BACKGROUND: Obstetrics and Gynaecology (O&G) is an evolving specialty that encompasses women's health at its core. The COVID-19 pandemic has caused significant patient care challenges, however simultaneously it has resulted in the interruption of clinical training and cessation of all elective work. Our primary aim was to assess the impact of the pandemic on the experiences of O&G trainees. METHODS: An email invite was sent to all 127 O&G trainees in Kent, Surrey and Sussex (KSS), inviting them to participate in an anonymous 33-question survey. The survey data was collected and analysed over a 4-week period. RESULTS: Of the 127 trainees sent the survey, 87 responded (69%). 39% and 75% of trainees agreed that the pandemic had a negative impact on their overall physical and mental wellbeing respectively. 43% agreed that the COVID-19 pandemic had adversely affected their obstetric training experience whilst almost all trainees stated a significant negative impact on benign gynaecology surgical training. Reassuringly, over 80% were positive they would recover from the negative impacts of COVID-19. CONCLUSIONS: It is evident that COVID-19 has impacted O&G trainees in several ways. Whilst we face uncertain times, we must firstly ensure the physical and mental well-being of all trainees. It is encouraging that non-emergency consultations and benign surgery are being restarted nationwide and whilst this will inevitably help with re-booting surgical training, we must also think "outside" the box and utilise other modes of teaching and training to safeguard learning whilst mitigating against the negative impacts of subsequent waves.

Getting back to business: considerations for restarting non-cancer gynaecological surgery following the COVID-19 peak.

As we begin to pass the first peak of the coronavirus pandemic, the backlog of routine gynaecological surgical work is becoming more apparent and continues to build day by day. The potential for further pandemic surges remain; however it is imperative that elective gynaecological surgery is restored safely, ethically and in a timely manner. The risks of COVID-19 transmission and potential increased surgical morbidity must be weighed up against the patient's ongoing symptoms and quality of life. Universal screening and testing of patients attending for routine surgery, as well as staff testing and retesting, will be fundamental to reducing the risks to both patients and staff, and avoiding the higher morbidity encountered when operating on asymptomatic infected patients. The aim of this paper is to explore pathways to safely reintroduce elective benign gynaecological surgery and the challenges that will be encountered including patient counselling and informed consent, surgical prioritisation and the screening and testing of patients and staff, as well as the logistical and ethical challenges of reintroducing benign surgery during COVID-19 times.

Covid 19 pandemic and gynaecological laparoscopic surgery: knowns and unknowns.

The worldwide impact of COVID 19 continues to be felt as hospitals in all countries reduce elective and non-urgent cases to allow staffing and resources to be deployed elsewhere. Urgent gynaecological and cancer procedures are continuing, and it is imperative all theatre staff are protected and risks of SARS-CoV-2 viral transmission reduced when operating on asymptomatic, suspected or confirmed COVID 19 patients. In particular, there are concerns relating to the transmission of COVID 19 during gynaecological laparoscopic surgery, arising from the potential generation of SARS-CoV-2 contaminated aerosols from CO2 leakage and the creation of smoke from the use of energy devices. The aim of this paper is to review all the up to date evidence, including experiences from China and Italy, to guide the safe management of such patients when undergoing gynaecological procedures.