Impact of COVID-19 Governmental Restrictions on Emergency General Surgery Operative Volume and Severity.

BACKGROUND: To describe the effect of the COVID-19 pandemic on emergency general surgery operative volumes during governmental shutdowns secondary to the pandemic and characterize differences in disease severity, morbidity, and mortality during this time compared to previous years. METHODS: This retrospective cohort study compares patients who underwent emergency general surgery operations at a tertiary hospital from March 1st to May 31st of 2020 to 2019. Average emergent cases per day were analyzed, comparing identical date ranges between 2020 (pandemic group) and 2019 (control group). Secondary analysis was performed analyzing disease severity, morbidity, and mortality. RESULTS: From March 1st to May 31st, 2020, 2.5 emergency general surgery operations were performed on average daily compared to 3.0 operations on average daily in 2019, a significant decrease (P = .03). No significant difference was found in presenting disease severity, morbidity, or mortality between the pandemic and control groups. DISCUSSION: This study demonstrates a decrease of 65% in emergency general surgery operations during governmental restrictions secondary to the COVID-19 pandemic. This decrease in operations was not associated with worse disease severity, morbidity, or mortality.

Impact of the COVID-19 Pandemic on Resident Physician Clinical and Educational Work Hours at a Large Sponsoring Institution.

BACKGROUND: The COVID-19 pandemic affected graduate medical education (GME) by decreasing elective procedures and disrupting didactic learning activities in 2020. Editorials have hypothesized that resident physicians worked fewer hours, therefore losing valuable experience, but we are not aware of studies that have objectively assessed changes in hours worked. OBJECTIVE: This study aims to identify differences secondary to the COVID-19 pandemic in resident work hours across all specialties at 3 geographically dispersed, integrated academic hospitals in a large sponsoring institution. METHODS: We obtained de-identified work hour data from all residency programs at Mayo Clinic in Arizona, Florida, and Minnesota. Resident work hours were compared between 2020 and 2019 from March to May. RESULTS: Work hours for 1149 and 1118 residents during the pandemic and control periods respectively were compared. Decreases in resident work hours were seen, with the largest decrease demonstrated in April 2020 when 19 of 43 programs demonstrated significantly decreased work hours. Residents worked more hours from home in April 2020 compared to the previous year (Arizona: mean 1 hour in 2019 vs 5.2 hours in 2020, P<.001; Florida: mean 0.7 hour in 2019 vs 6.5 hours in 2020, P<.001; Minnesota: mean 0.8 hour in 2019 vs 10.2 hours in 2020, P<.001). CONCLUSIONS: The COVID-19 pandemic was associated with a decrease in work hours in some, but not all, specialties. The decrease in on-site work was only partially offset by an increased number of hours worked from home.

Impact of Elective Case Postponement Secondary to COVID-19 on General Surgery Residents' Experience: Operative Cases Logged at Three Academic Teaching Hospitals.

OBJECTIVE: This study aims to characterize changes in the total operative cases logged by general surgery residents across three residency programs. DESIGN: Retrospective cohort study. De-identified case logs, divided by institution and post graduate year (PGY) level, were obtained from the general surgery training programs at three academic hospitals. Total cases logged were calculated over the pandemic period (start: beginning of residency, end: May 31st, 2020) and the control period (start: beginning of residency, end: May 31st, 2019). SETTING: Three academic tertiary hospitals (Mayo Clinic - Arizona, Mayo Clinic - Florida, and Mayo Clinic - Rochester) PARTICIPANTS: All general surgery residents at these three hospitals, including 25 residents at Mayo Clinic - Arizona in both the pandemic and control period, 16 and 15 residents at Mayo Clinic - Florida in the control and pandemic period, respectively, and 81 and 77 residents at Mayo Clinic - Rochester in the control and pandemic period, respectively. RESULTS: Only PGY 4 general surgery residents at Mayo Clinic - Rochester had a decrease in operative cases logged in the pandemic period (759 cases on average compared to 1010 cases, p = 0.005), with no other changes in operative cases logged noted. CONCLUSIONS: While elective cases were postponed secondary to the COVID-19 pandemic for around 1 month in the spring of 2020, the decrease in elective cases did not greatly impact overall resident operative cases logged for residents in three general surgery residency programs.

Showcasing a General Surgery Residency Program During the COVID-19 Pandemic.

OBJECTIVE: The virtual interview season has challenged general surgery residency programs to recruit applicants through the loss of visiting clerkships, tours, and time with residents. Webinars, increased informal resident and faculty sessions, and live-narrated video tours are potential solutions. This study aimed to assess the effectiveness of these elements in virtually showcasing a residency program during the virtual interview season. DESIGN/SETTING: Prospective applicants to one general surgery residency program (Mayo Clinic in Rochester, Minnesota) were invited to attend six webinars: Program Overview, Simulation Education, Diversity, Resident Life, Mingle with Residents, and Last-Minute Q&A. An anonymous survey was sent to all registered participants of the webinars. Interviewees participated in a preinterview social hour with resident and faculty and a live-narrated video tour of our facilities during their interview. A second anonymous survey was sent to all interviewees. PARTICIPANTS: Webinars - 33% of 159 unique registrants surveyed participated. Interviews - 46% of 109 interviewees surveyed participated. RESULTS: Average satisfaction with the webinars was 9.4/10. Overall, 98% of attendees felt that the webinars gave them a "feel" for the program. Attendees found the Last-Minute Q&A webinar and Program Overview to be most useful. For resident-led webinars, 100% of attendees felt that themed break-out rooms were effective. Average satisfaction with the interviews was 4.4/5. Interviewees rated access to faculty and residents highly (4.4/5 and 4.5/5, respectively). 98% of interviewees found the live-narrated video tour helpful. CONCLUSIONS: A webinar curriculum can be effective in virtual residency recruitment, as prospective applicants developed a good understanding of the resident program after participating. Further, live-narrated video tours and purposefully incorporating several avenues for informal conversations with residents and faculty can successfully address applicant concerns about virtual interviews.

Conducting Virtual Simulated Skills Multiple Mini-Interviews for General Surgery Residency Interviews.

OBJECTIVE: We describe the feasibility of transitioning simulated skills assessments during general surgery interviews from an in-person to virtual format. DESIGN/SETTING: Technical and nontechnical skill multiple mini-interviews (MMIs) were performed virtually and assessed for 109 applicants during virtual general surgery interviews over 2 days at a tertiary academic medical center. RESULTS: We demonstrate the feasibility of virtually assessing general surgery residency applicants' technical and non-technical skills. Using a virtual MMI format during general surgery interviews, we assessed communication, emotional intelligence, anatomical knowledge, interpretation of medical tests, knot tying, and suturing. Four tasks (communication, emotional intelligence , anatomical knowledge, and interpretation of tests) were assessed synchronously by trained general surgery interns. Applicants submitted a recording of themselves performing knot tying and suturing tasks, which were asynchronously assessed after the interview day. Applicants rated the MMI experience highly (4.3/5) via postinterview day survey and the majority of applicants felt that station objectives were met in the virtual format. CONCLUSIONS: We report a successful experience implementing technical and nontechnical virtual MMIs with capacity for 120 applicants during general surgery residency interviews. In the midst of a COVID-19 pandemic, the ability to assess surgical leaners virtually is essential. Virtual skills assessments may provide a more comprehensive picture of applicants and enable residency programs to better assess residents when gathering in person is not feasible.