The lasting impact of COVID-19 on surgical training from the perspective of surgical residents and consultants in Saudi Arabia: a nationwide cross-sectional study.

BACKGROUND: Since the start of the COVID-19 pandemic, many precautionary measures have been set to curb the transmission of the virus. That has led to changes, most notably in surgical education, like lack of surgical exposure and clinical activities. However, the question aiming at the impact of changes made by the COVID-19 pandemic on surgical education and its extent remains unanswered. MATERIALS & METHODS: An electronic survey was distributed among surgical residents and consultants from all over Saudi Arabia, starting from the 6th till the 21st of July, 2021. Descriptive statistics were presented using counts and proportions (%). Study subjects were compared with the different perspectives during the COVID-19 pandemic by using Chi-square test. A p-value cut-off point of 0.05 at 95% CI was used to determine statistical significance. RESULTS: A total of 243 out of 500 surgical residents and consultants responded to the survey, giving a response rate of 48.6%. The majority were general surgeons (50.5%) and cardiothoracic surgeons (21.8%). Nearly 66% of surgeons, both residents and consultants, strongly agreed on the importance of training for infectious disease outbreaks. 44.7% of the consultants and 48% of the residents showed their willingness to respond to the pandemic regardless of its severity. Over 70% of surgeons agreed that developing clinical skills was compromised by the COVID-19 pandemic, and 40% expected a negative impact of the COVID-19 on their operative skills. Simulation was ranked best for disaster medicine training by over 77% of the respondents. The most common concern among surgeons during the COVID-19 pandemic was their family's health and safety. Regarding virtual curriculum components, online practice questions and surgical videos were preferred by the surgical consultant and resident, respectively. CONCLUSIONS: Although the COVID-19 pandemic has impacted surgical education, it has highlighted the alarming need for adopting new components. For surgical training programs, we recommend improving the virtual curriculum, incorporating disaster medicine training, providing psychological services, and prioritizing immunization and treatment access for surgeons' families.

[Psychotherapy prescribed by accident insurance consultants : Important component in treatment procedures of the statutory accident insurance]. / D-ärztlich veranlasste Psychotherapie : Wichtiger Baustein im Heilverfahren der gesetzlichen Unfallversicherung.

BACKGROUND: In Germany around 1 Million working and commuting accidents per year are officially registered. Since several years this number is constantly at this high level, only just since the appearance of the actual Covid pandemia significantly lower because of lockdowns and increase of homeoffice workplaces. OBJECTIVE: To ensure the professional care of psychotraumatic sequelae of work-related injuries, in 2012 new regulations were introduced by the DGUV, the national umbrella organization of the German statutory health insurances. This healthcare reform (named "Psychotherapeutenverfahren", verbally translated: psychotherapists' procedure) is looked at 10 years later. Is the new regulation accepted by the surgeons' community? What case constellations can be observed? MATERIAL AND METHODS: The use of this new instrument among trauma surgeons was evaluated by national data for the complete years 2013-2021. Additionally, we include regional data and case reports from a multidisciplinary medical facility including trauma surgery and psychiatry, located in Güstrow (Northeast Germany). RESULTS: Nationwide the percentage of psychotherapy amongst the regular treatment has doubled between 2013 and 2021 from 0.47 to 0.96%. DISCUSSION: Looking at the first 10 years of its clinical implementation, the new German psychotherapy regulation is apparently well accepted by the accident insurance consultants. As data from population based studies are not available, the actual percentage of psychological sequelae of accidents in this cases is not known yet. So there is further need of research and training in this interdisciplinary field to ensure appropriate treatment of victims of work-related accidents. The integration of psychotraumatological facts in the educational agendas of accident insurance consultants has already started.

The recovery of training and education post-COVID-19: the importance of supporting the consultant workforce.

BACKGROUND/AIMS: Since the COVID-19 pandemic began, training and education have been significantly disrupted, causing an incalculable effect on trainees. However, the consultant workforce is crucial to the success of training recovery. The motivation of the consultant workforce to assist in training recovery, in a context of significant workload and increasing pressures on resources, is currently unknown. METHODS: This survey gathered the consultant workforce's views on assisting training recovery at one site of a large NHS foundation trust. RESULTS: There was reduced motivation to engage in training and education when compared to pre-pandemic levels, widespread indicators of burnout, and changes in attitude towards reducing their working hours and early retirement. CONCLUSIONS: These findings demonstrate a worrying trend that is likely to be replicated nationwide, which highlights the need to support consultants to avoid further disruption to training recovery.

Qualitative study exploring the well-being experiences of paediatric critical care consultants working in the UK during the COVID-19 pandemic.

OBJECTIVES: The aim of this study was to examine the well-being experiences of consultants working in paediatric critical care (PCC) settings in the UK during the COVID-19 pandemic. DESIGN: Qualitative design using individual interviews and thematic analysis. SETTING: PCC. PARTICIPANTS: Eleven medical consultants working in PCC in a range of PCC settings/transport teams in the UK from nine units participated. Participants ranged in years of experience as a consultant from four to 23 years. METHODS: A set of open semistructured questions were used to elicit information about participants' experiences of workplace well-being. Interviews were audiorecorded and transcribed. FINDINGS: Thematic analysis identified six themes and data saturation was reached. These were as follows: (1) positive and negative impact of working during COVID-19, (2) job satisfaction and public scrutiny in the unique environment of PCC, (3) supporting the workforce through modified shift work, (4) perceptions of support and recognition offered from the hospital management, (5) successful coping strategies are personal and adaptive, and (6) importance of civility and good teamwork CONCLUSION: Findings show that consultants' well-being is challenged in a number of ways and that the solutions to the problem of burn-out are multifaceted. Action is required from individual consultants, clinical teams, hospital management and national regulatory bodies. Our work corroborates the recent General Medical Council report highlighting doctors' core needs for well-being: autonomy, belonging, competence. Burn-out is a long-term problem, requiring sustainable solutions. Future research needs to develop and evaluate the effectiveness of evidence-based interventions to improve consultants' well-being. Trials of effectiveness need to present evidence that will persuade hospital management to invest in their consultants' well-being within the economic context of reduced budgets and limited PCC workforce.

Vulnerability of African Neurosurgery to Predatory Journals: An Electronic Survey of Aspiring Neurosurgeons, Residents, and Consultants.

BACKGROUND: Predatory journals (PJs) publish research with little to no rigorous peer review in exchange for money. It is unclear what proportion of researchers is vulnerable to PJs and which factors are associated with vulnerability. The aim of this study was to evaluate the vulnerability of African neurosurgery researchers to PJs and identify their correlates. METHODS: A 3-part electronic survey in English and French versions was distributed via social media to African consultants and trainees from November 1 to December 1, 2021. Bivariable relationships were evaluated with χ2 test, Mann-Whitney U test, Spearman ρ correlation, odds ratios, and 95% confidence intervals. A P value < 0.05 was considered statistically significant. RESULTS: There were 101 respondents to the survey (response rate 56.1%). Respondents had mean age of 34.9 years, 82.2% were male (n = 83), 38.6% were consultant neurosurgeons (n = 39), and 33.7% were from Central Africa (n = 34). Of respondents, 66 had published ≥ 1 articles in the past, and 13 had published at least 1 article in a PJ. A PJ had contacted 34 respondents via e-mail, and 8 respondents had reviewed articles for a PJ. The Think. Check. Submit initiative and Beall's list were familiar to 19 and 13 respondents, respectively. Publication in PJs was correlated with the respondent's age (R = 0.23, P = 0.02) and total scholarly output (R = 0.38, P < 0.01). CONCLUSIONS: Young African neurosurgery researchers are vulnerable to PJs primarily because they are not familiar with the concept of PJs or how to identify them.

The benefits of dual-consultant operating in complex breast reconstruction: A retrospective cohort comparison study.

BACKGROUND: Dual-consultant operating (DCO) has been introduced in a multitude of surgical specialities. This retrospective cohort comparison study seeks to delineate any benefits DCO may confer on list utilisation, patient safety and training opportunities. METHODS: A retrospective cohort comparison of all free-flap breast reconstruction cases conducted at a single centre by five consultant plastic surgeons in the period May 2016-May 2020. RESULTS: A total of 281 patient records were used for analysis; 146 cases were dual consultants compared with 135 single consultants, representing 186 and 158 free flaps, respectively. Patient demographics were near identical in terms of patient age, BMI and ASA grade. Operating times were significantly reduced for both unilateral (mean reduction 59.49 min) and bilateral cases (mean reduction 38.14 min) with the presence of dual consultants. The mean length of stay for dual-consultant cases was on average 0.35 days less than for single consultant cases (p = 0.04). Dual-consultant case complications were less severe than those of single consultant cases (mean Clavien-Dindo severity 1.35 vs 0.96, p = 0.05). The rates of trainee one-to-one consultant training were increased in dual-consultant cases when preparing vessels (0.08 vs 0.35, p=<0.01) and performing anastomosis (0.63 vs 0.77, p = 0.03). CONCLUSIONS: DCO for complex breast reconstruction confers significant benefits to operating time, list utility and patient safety whilst protecting training opportunities for trainees. Plastic surgery departments looking to redesign services in the post-SARS-CoV-19 era should consider its adoption into their enhanced recovery protocols.

Rapid introduction of virtual consultation in a hospital-based Consultant-led Antenatal Clinic to minimise exposure of pregnant women to COVID-19.

The COVID-19 global pandemic dictated rapid change to outpatient services within our London-based maternity hospital. Coupled with long waiting times in the Consultant-led Antenatal clinic, we aimed to reduce hospital footfall and unnecessary contact with a clinically vulnerable patient population by reducing face-to-face consultations. Numerous specialties have already successfully implemented safe and effective teleconferencing, allowing remote review while reducing the risks posed by face-to-face contact. A target to see at least 15% of women remotely was set to reduce footfall in the Consultant-led Antenatal Clinic. We aimed to reduce face-to-face waiting times to a mean of 30 min. In March 2020, clinics were prevetted by the clinic consultant to carefully select appropriate women suitable for video or telephone consultations. Clinic templates were changed, increasing appointment times by 5-25 min each. 'AccuRx' software was tested and used to communicate appointment details and conduct the consultation. In-person waiting times in the clinic and number of virtual consultations over a 3-month period was recorded, along with qualitative feedback from service users and staff through surveys and departmental meetings. Mean waiting times were reduced by 33% from 45-30 min and multiple service-user benefits were noted, including partner involvement, convenience of waiting for appointments at home and removing requirement for childcare. However, limitations of internet connectivity, need for time to prevet clinics and lack of a robust administration system to inform women of their appointment type were highlighted. Further work is required in these areas to ensure sustainability and improvement of this process for the future.

Oral and Maxillofacial Surgery (OMFS) Consultant Workforce in the UK: reducing consultant numbers resulting from recruitment issues, pension pressures, changing job-plans, and demographics when combined with the COVID backlog in elective surgery, requires urgent action.

Mean retirement age for UK doctors is 59.6 years, giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts typically restricted to a maximum of 10 sessions (40 hours), increasing proportions of consultants working less than full time (LTFT), all combined with the backlog of elective care created by COVID-19 will create a significant gap between workforce capacity and clinical demand. The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification. Changes in job plans were estimated using data from the BAOMS Workforce Census and from recently advertised posts. Reports of unfilled posts were collated by OMFS Regional Specialty Professional Advisors (RSPAs). First degree dates were identified for 476 OMFS substantive consultant posts. Estimated current average age of OMFS consultants was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 and 23% of the current consultant workforce above the average retirement age for doctors. The 10 sessions of new OMFS consultants posts is significantly less than existing consultants' average of 12.1 sessions (48.4 hours). Unfilled consultant posts in Great Britain are 13% of the total compared to 20% in Northern Ireland and Ireland. Many (23%) of the OMFS consultant workforce are above average retirement age. Forty-hour contracts; new consultants working LTFT; and early loss of senior colleagues because of pension pressure will reduce NHS' capacity to treat OMFS disorders and injuries. This paper suggests increasing consultant posts, increasing trainee numbers, and actively retaining senior surgeons to maintain capacity.

Peer assessment after clinical exposure (PACE): an evaluation of structured peer support for staff in emergency care.

BACKGROUND: There is an increasing body of evidence that identifies psychological stressors associated with working in emergency medicine. Peer Assessment After Clinical Exposure (PACE) is a structured programme designed to support staff following traumatic or chronic work-related stressful exposure. The first author of this study created the PACE programme and implemented it in one emergency department (ED). AIM: A service evaluation designed to explore the thoughts and experiences of the staff who accessed the PACE support service. METHOD: Participants were selected by a non-probability convenience strategy to represent the ED staff population. The study cohort ranged from junior staff nurse level to emergency consultant. Data were collected using a semi-structured interview and examined by the method of interpretative phenomenological analysis. FINDINGS: This study confirmed the findings of previous research that current pressures within the ED include crowding, time pressure and working within an uncontrollable environment. Eight participants identified an absence of previous emotional support resulting in dissociation and avoidance behaviours following traumatic exposure. Overall, the PACE service was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure. CONCLUSION: PACE received a positive response from staff. This service presently does not exist elsewhere in the NHS so further research will be needed to evaluate its long-term impact and effectiveness on a wider scale.

The family physician as a primary care consultant - the Mossel Bay experience.

The South African family physician (FP) is an expert generalist who has a number of roles to strengthen the district health system. A research study on FPs in district hospitals has previously demonstrated an impact; however, more evidence on impact in primary health care (PHC) is needed. By serving as a consultant for the PHC team, the FP may improve access to care, capacitate team members, enhance comprehensiveness of care, and improve coordination and continuity of care. This report narrates the story of how one of the FPs at a rural district hospital recorded his experience of being a consultant to the PHC team and was able to self-audit the experience. A self-designed audit tool analysed 1000 patient consultations with the FP and enabled a reflection on the coronavirus disease 2019 (COVID-19)-related changes to the consultant role. There was a clear need for FPs to consult patients with complex multi-morbidity and multifaceted psychosocial aspects to their illness, in consultation with their team members. Patients were referred to them by medical officers, other specialists, family medicine registrars, allied healthcare professionals and nurse practitioners. The FP's ability to strengthen the PHC service outside the district hospital may be enhanced by creating more FP posts at a subdistrict level to support high-quality, team-based primary care in line with the PHC policy directions.

From Consultant to Co-investigator: One Diabetes Research Team's Journey of Patient Engagement.

Patients with diabetes are experts in the lived experience of self-management, making patient engagement beyond the role of research "subject" imperative for the creation of health care solutions that meaningfully address the problems they identify. We discuss our research team's relationship with our university's College Diabetes Network (CDN), an advocacy and support group for emerging adults with diabetes. Our collaborative research relationship has spanned three years, and multiple research studies with members serving as co-designers, consultants, and co-investigators. We discuss the CDN's role in two particular studies in which CDN members made substantive contributions to study design, instrument adaptation, and interpretation of findings. Key CDN members played a larger role in research activities and facilitated sustained engagement with the larger university CDN chapter. Barriers encountered included navigating research regulatory requirements while engaging CDN members in research and facilitating sustained engagement as CDN membership changes.

Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study.

BACKGROUND AND OBJECTIVE: Healthcare providers should use personal protective equipment (PPE) when performing aerosol-generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures in a manikin model with or without PPE for prevention of SARS-COVID-19 transmission. METHODS: A randomised controlled cross-over (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant-nurse teams and 12 resident-nurse teams. The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE and discomfort/limitations using PPE. RESULTS: There were significant differences in timing of PPV initiation (consultant-nurse teams: mean difference (MD) 6.0 s, 95% CI 1.1 to 10.9 s; resident-nurse teams: MD 11.0 s, 95% CI 1.9 to 20.0 s), duration of tracheal intubation (consultant-nurse teams: MD 22.0 s, 95% CI 7.0 to 36.9 s; resident-nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s) and chest compressions (consultant-nurse teams: MD 32.3 s, 95% CI 14.4 to 50.1 s; resident-nurse teams: MD 9.1 s, 95% CI 0.1 to 18.1 s). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48). CONCLUSIONS: In a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE. TRIAL REGISTRATION NUMBER: NCT04666233.

Perspectives of Remote Volunteer Palliative Care Consultants During COVID: A Qualitative Study.

CONTEXT: A novel remote volunteer program was implemented in response to the initial COVID-19 surge in New York City, allowing out-of-state palliative care specialists to serve patients and families in need. No study has detailed the perceptions of these consultants. OBJECTIVES: To understand the experiences of remote volunteer palliative care consultants during the initial COVID-19 surge. METHODS: This qualitative study utilized a thematic analysis approach. During January and February 2021, we conducted one-on-one semi-structured interviews with 15 board-certified palliative care physicians who participated in the program. Codes and emerging themes were identified through iterative discussion and comparison. RESULTS: Five overarching themes (with sub-themes in parentheses) were identified: 1) motivations for participating in the program, 2) logistical evaluation of the program (integration, telehealth model, dyad structure and debriefing sessions), 3) barriers to delivery (language and cultural differences, culture of high-intensity care, legal and administrative differences), 4) emotional burden (moral distress, burnout), and 5) ideas for improvements. Notably, participants observed institutional and cultural differences that posed challenges to delivery of care. Many expressed feelings of distress related to the uncertainty and scarcity caused by the pandemic, although volunteering may have been protective against burnout. CONCLUSION: This study provides an in-depth look at the experiences of remote volunteer palliative care consultants during the initial COVID-19 surge from the unique perspectives of the consultants themselves. Participants expressed overall positive and meaningful experiences and felt that the model was appropriate given the circumstances. Additionally, participants provided recommendations that could guide future implementations of similar programs.