A Web-based Cross-sectional Survey to Assess the Effect of Pandemic on Medical Education of Surgery Residents in a Tertiary Care Hospital

Aim: Effect of pandemic on medical education of surgical residents in a tertiary care hospital in Bihar Methods: A web-based survey was conducted to assess the effect of COVID-19 on the residents in various surgical specialties in our institute. The "open epi" software was used to calculate the sample size. The interview questions were generated through focus group discussions with five surgery residents from various specialties. Maslach burnout index (MBI) was used to assess burnout experienced by surgical residents. It was modified such that each of the individual components was asked as a yes or no question. Yes, was considered as 1 point and not as 0 points. The score of 22 questions was simply added. Result(s): A total of 100 surgical residents completed the survey out of 130 residents who received it (response rate 76.9%). Of the 100 respondents, 58(58%) were male, and 86 (86%) residents were less than 30 years of age. 24 percent of respondents were in the first year of their residency, 43% in their second year, and the remaining in the final year. Residents from 8 surgical specialties participated in the survey 85(85%) surgical residents felt the reduction in bed strength, and 83(83%) felt reduction in the number of patients seen by a resident in the outpatient clinic had impacted their learning. The amount of time spent on research work, however, increased by 66(66%). The 76(76%) residents efficiently utilized telemedicine for outpatient care, and 69(69%) residents felt telemedicine had improved patient care. There was a significant (paired t test;p<0.05) reduction in working hours since the pandemic began (8.45+/-2.15 hours) when compared to pre-pandemic time (13.55+/-2.03 hours). Hands-on surgical training was significantly affected. MBI was modified for the sake of simplicity. The average score before pandemic was 13.78+/-2.56, and after the pandemic, it was reduced to 7.63+/-2.35, showing a statistically significant reduction in burnout among residents (p<0.001). Conclusion(s): Surgical trainees played a significant role in taking care of many COVID-19 patients at the cost of their training. The decrease in working hours due to the pandemic has provided more time for research work and reduction in burnout. Copyright © 2021, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

A Literature Review about Impact of COVID-19 on Operative Activity, Educational Process and Mental Health of Surgical Residents

Background and aim: The COVID-19 pandemic has negatively affected all sections of society, including medical staff. Based on a review study, the aim of this study was to look at the impact of the COVID-19 pandemic on surgical residents, educational process, surgical, and mental health components. Material and methods: The results of this study were based on the method of review studies. To conduct this study, a systematic search of international databases including Web of Science, Science Direct, Scopus, PubMed, and Google Scholar between 2000 and 2021 was first performed using related keywords. Finally, 30 articles were chosen based on the scope and the necessary criteria for obtaining data, and the needed results were extracted from them. Results: The results showed that 6776 residents and 220 program managers participated in these studies, with the largest sample sizes coming from the United States (3187 people), India (716 people) and Italy (661 people), respectively. Furthermore, the results showed that the COVID-19 pandemic had a negative effect on surgical residents', educational activities, as well as mental health, and surgical activities. Conclusion: Based on the results, it can be concluded that COVID-19 pandemic has a negative effect on surgical residents' educational process, as well as increased their anxiety and stress, and for that reason, proper planning by managers is needed to reduce these negative effects. © 2021 Negahi A, et al.

Surgical Residents' Perspective on Online Education during COVID-19 Pandemic.

<b> Introduction: </b> The COVID-19 pandemic is an exceptional situation which has rigorously affected surgical education and training worldwide. This current situation has carved innovative ways like online teaching to counter the challenges of the pandemic faced by a surgical resident. However, online teaching is not complimentary to bedside teaching which is a traditional practice. Therefore, we designed this study to assess the residents' perceptive towards online learning as a mode of education which is extensively implemented during the COVID-19 pandemic at our centre. </br></br> <b> Methods:</b> This study was a cross-sectional survey. An online Google survey was circulated among junior residents in the department of General Surgery. This survey included residents' demographic profile, effect on working hours, their perception with online teaching, and effect on their surgical training during the COVID 19 pandemic. </br></br> <b>Results:</b> A total of 95 junior residents participated in this study. Surgical training and teaching was rigorously affected according to most of them and they also believe they have lost crucial training time in their tenure as a surgical resident. A majority found the communication with the faculty during online teaching adequate; however, the main drawback of online classes was the lack of clinical exposure and practical experience. Only 4.2% preferred 100% online teaching in future. </br></br> <b> Conclusion:</b> COVID-19 pandemic has affected surgical training much more as compared to other medical fields. However, we believe online education is still a potential instrument during the COVID-19 pandemic. Online learning platforms can be used in future as a supplement to time-honoured classroom teaching and didactic lectures.

Burnout syndrome among residents of different surgical specialties in a tertiary referral teaching hospital in Indonesia during COVID-19 pandemic.

INTRODUCTION: Burnout is experienced frequently by residents, especially during COVID-19 pandemic. Impacts of the pandemic on clinical workload and training program of the residents has also resulted in burnout, which may impact their clinical performance and safety. Therefore, this paper aims to assess burnout syndrome among surgical residents in Indonesia during COVID-19 pandemic. METHODS: A cross-sectional survey was conducted on 120 surgical residents (from orthopedics, general surgery, and urology department) of a tertiary referral teaching hospital in Malang using web-based questionnaire. Personal data form and Maslach Burnout Inventory (MBI) for medical personnel were used. There are 3 subscales of MBI: emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). Comparative and correlative analysis were performed to analyze the socio-demographic, academic, and work-related factors in relation to the subscales scores of MBI-HSS and the presence of burnout. RESULTS: Burnout were experienced by 56.67% of residents in this study. There were statistically significant association regarding burnout and marital status, residency specialty, year of residency, and working hours upon analysis of mean and classification of subscale scores of MBI with the examined factors. CONCLUSION: This study showed that burnout is a major issue in surgical residents during COVID-19 pandemic and may be associated with certain socio-demographic, academic, and work-related factors. Further studies to identify factors contributing to burnout in residents during COVID-19 pandemic are needed. It is imperative to formulate resident-centered strategies to prevent and address burnout among residents to ensure their overall well-being during this pandemic.

Current Surgical Trainee Perceptions and Experiences in Telehealth.

Introduction:Broad expansion of telehealth technologies has been implemented during the coronavirus disease 2019 (COVID-19) pandemic to allow for physical distancing and limitation of viral transmission within health care facilities. Although telehealth has been studied for its impact on patients, payors, and practitioners, its educational impact is largely unstudied. To better understand the trainee experience and perception of telehealth during the COVID-19 pandemic, we conducted a survey of the membership of the American College of Surgeons Resident and Associate Society (RAS).Methods:An anonymous survey was sent to members of RAS. Descriptive analysis was used to report experiences and perceptions. Chi-square analysis was used to compare cohorts with and without exposure to telehealth.Results:Of the 465 RAS respondents, 292 (62.8%) reported knowledge of telehealth technologies at their institutions. The majority of these respondents experienced a decrease in in-person clinic volume (94.4%) and an associated increase in virtual clinic volume (95.7%) related to the COVID-19 pandemic. Trainee integration into telehealth workflows increased drastically from prepandemic levels (11% vs. 54.5%, p < 0.001). Likelihood of trainee exposure to telehealth was associated with university-based training programs or larger program size. Trainees demonstrated a desire for more integration and development of curricula.Conclusions:These data serve as the first description of surgical trainee experience with, and opinion of, telehealth. Trainees recognize the importance of their integration and training in telehealth. These results should be used to guide the development of workflows and curricula that integrate trainees into telemedicine clinics.

Telemedicine Experience of General Surgery Trainees: Impact on Patient Care and Education.

OBJECTIVE: The COVID-19 pandemic has had a significant impact on patient care, including the increased utilization of contact-free clinic visits using telemedicine. We looked to assess current utilization of, experience with, and opinions regarding telemedicine by general surgery residents at an academic university-based surgical training program. DESIGN: A response-anonymous 19-question survey was electronically distributed to all general surgery residents at a single academic university-based general surgery residency program. SETTING: University of Southern California (USC) general surgery residency participants: Voluntarily participating general surgery residents at the University of Southern California. RESULTS: The response rate from USC general surgery residents was 100%. A majority of residents (76%) had utilized either video- or telephone-based visits during their careers. No resident had undergone formal training to provide telemedicine, although most residents indicated a desire for training (57.1%) and acknowledged that telemedicine should be a part of surgical training (75.6%). A wide variety of opinions regarding the educational experience of residents participating in telemedicine visits was elicited. CONCLUSIONS: The COVID-19 pandemic brought telemedicine to the forefront as an integral part of future patient care, including for surgical patients. Additional investigations into nationwide telemedicine exposure and practice among United States general surgery residencies is imperative, and the impact of the implementation of telemedicine curricula on general surgery resident telemedicine utilization, comfort with telemedicine technology, and patient outcomes are further warranted. COMPETENCIES: Practice-based learning, systems-based practice, interpersonal and communication skills.

Surgical Education and Training during the COVID-19 Pandemic: Strategies and Solutions for Pakistan.

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during the pandemic. Hospitals' implementation of "shift schedules" for rotations helps continue training while minimising risks. Moreover, examination boards and residency programmes must appropriately tailor their eligibility criteria and assessment processes to the current situation. Lastly, it is vital to safeguard trainees' mental wellness during the pandemic and after by ensuring readily available professional psychological support when needed.

Analysis of the impact of the pandemic on surgical residency programs during the first wave in Argentina: A cross - sectional study.

INTRODUCTION: COVID - 19 emerged as a global pandemic in 2020 and affected the teaching methods at all levels. Surgical education has also been significantly affected by this pandemic, but the effect remains unknown. We developed a survey in order to obtain more information on how this pandemic affected the training and education of surgical residency programs. MATERIAL AND METHODS: Cross-sectional study. We surveyed 195 residents of various surgical programs, from August 20th to September 30th, 2020, in Córdoba, Argentina. The effect of the COVID - 19 pandemic was analyzed on surgical training, on the academic program, and professional burnout. RESULTS: The volume of surgical cases performed during the pandemic decreased dramatically, affecting mainly residents of lower years. Comparing the number of cases (>7) that residents carried out per week (Pre pandemic vs pandemic), we found that PGY - 1: 47% vs 9%; p = 0.01 and PGY - 2: 46% vs 8%; p = 0.03. 83.2% reported that the impact of the pandemic affected their surgical training negatively and 45% were not adequately trained to carry out their surgical activity in the residency program. On the other hand, 71.3% affirmed that this health emergency allowed them to dedicate more time to the development of their academic training. CONCLUSION: This is the first cross - sectional survey study that shows the impact of the pandemic on surgical residences during the first wave in Argentina. Surgical training performed by residents had a negative impact.

Effect of COVID-19 on Surgical Training Across the United States: A National Survey of General Surgery Residents.

INTRODUCTION: COVID-19 emerged as a global pandemic in 2020 and has affected millions of lives. Surgical training has also been significantly affected by this pandemic, but the exact effect remains unknown. We sought to perform a national survey of general surgery residents in the United States to assess the effect of COVID-19 on surgical resident training, education, and burnout. METHODS: An anonymous online survey was created and distributed to general surgery residents across the United States. The survey aimed to assess changes to surgical residents' clinical schedules, operative volume, and educational curricula as a result of the COVID-19 pandemic. Additionally, we sought to assess the impact of COVID-19 on resident burnout. RESULTS: One thousand one hundred and two general surgery residents completed the survey. Residents reported a significant decline in the number of cases performed during the pandemic. Educational curricula were largely shifted toward online didactics. The majority of residents reported spending more time on educational didactics than before the pandemic. The majority of residents feared contracting COVID-19 or transmitting it to their family during the pandemic. CONCLUSIONS: COVID-19 has had significant impact on surgical training and education. One positive consequence of the pandemic is increased educational didactics. Online didactics should continue to be a part of surgical education in the post-COVID-19 era. Steps need to be taken to ensure that graduating surgical residents are adequately prepared for fellowship and independent practice despite the significantly decreased case volumes during this pandemic. Surgery training programs should focus on providing nontechnical clinical training and professional development during this time.

The impact of COVID-19 pandemic on surgical residency programmes in Italy: a nationwide analysis on behalf of the Italian Polyspecialistic Young Surgeons Society (SPIGC).

INTRODUCTION: Recently, Italy has been heavily hit by COVID-19 pandemic and today it is still one of the most affected countries in the world. The subsequent necessary lockdown decreed by the Italian Government had an outstanding impact on the daily life of the entire population, including that of Italian surgical residents' activity. Our survey aims to evaluate the impact of COVID-19 on the training programme of Italian surgical residents. MATERIALS AND METHODS: We designed a 12-item-electronic anonymous questionnaire on SurveyMonkey© web application. The survey was composed of different sections concerning demographic characteristics and impacts of COVID-19 on the concrete participation in clinical, surgical and research activities. Future perspectives of responders after the pandemic were also investigated. RESULTS: Eighty hundred responses were collected, and 756 questionnaires were considered eligible to be included in the study analysis. Almost 35 and 27% of respondents experienced, respectively, complete interruption of surgical and clinical activities. A subgroup analysis, comparing the COVID-19 impact on clinical activities with demographics data, showed a statistically significant difference related to specialties (p = 0.0062) and Italian regions (p < 0.0001). Moreover, 112 residents have been moved to non-surgical units dealing with COVID-19 or, in some case, they voluntarily decided to interrupt their residency programme to support the ongoing emergency. CONCLUSION: Our survey demonstrated that COVID-19 pandemic has severely impacted the educational programme of Italian surgical residents. Despite many regional differences, this survey highlighted the overall shortage of planning in the re-allocation of resources facing this unexpected health emergency.

Impact of COVID-19 on surgical residency programs in Pakistan; A residents' perspective. Do programs need formal restructuring to adjust with the "new normal"? A cross-sectional survey study.

BACKGROUND: Due to high-risk exposure of surgical residents to coronavirus, surgical residency programs have changed their training methods and working hours drastically. The purpose of this study is to find out the positive and negative impacts of the pandemic on surgical residency programs and on the lives of surgical residents. MATERIALS AND METHODS: A cross-sectional study was conducted on 112 surgical residents of a tertiary care hospital in Pakistan, with a mean age of 30.5 years from all the departments of surgery using a self-made, validated 40-point questionnaire comprising three sections. The last section also included modified Maslach Burnout inventory. RESULTS: Of all the residents, 97 (86.6%) stated that their surgical hands-on duration is adversely affected by the pandemic. As for clinical exposure, 92 (82.1%) trainees responded that their clinical exposure is affected too. Among all the subjects, 69 (61%) were concerned about transmitting it to their family members and 43 (38.4%) affirmed on being afraid of dying because of their direct exposure. On the brighter side, the average number of working hours per week for surgical residents were reduced from 81.10 ± 6.21 to 49.16 ± 6.25 (p < 0.001) due to the outbreak. Modified Maslach Burnout inventory score was 8.33 ± 2.34 after the outbreak, showing statistically significant reduction in burnout among the surgical residents (p < 0.001). CONCLUSION: The changes in the surgical residency programs amidst the pandemic has reduced the working hours, hands-on and clinical exposure of the surgical residents. Moreover, the situation has provided an opportunity to explore efficient methods of learning that can lead to lesser burnout. However, psychological burdens of surgical residents like fear of acquiring the infection should be appropriately addressed.