Optimising surgical training in the time of COVID-19 - Victorian regional teaching hospital experience

ABSTRACT

Introduction & Objectives: The significant reduction in elective surgery initially outlined by the National Cabinet in March 2020 and instituted by respective state governments due to the COVID-19 pandemic, led to a parallel overall reduction in patient based surgical training opportunities for trainees. The physical patient, as a training resource, was in short supply. In order to achieve competency and proficiency, surgical training in Australia and New Zealand is structured around each of the ten Royal Australasian College of Surgeons (RACS) competencies and occurs predominantly in a patient based clinical setting. Our objective was to quantify the impact of COVID-19 on surgical training, to appraise the establishment of our local regional hospital provision of urology service plan and assess the impact COVID-19 had on unit workload. We review the adaptive approach to surgical training taken up in our institution and highlight the unique challenges trainees were faced with due to the pandemic, allowing them to demonstrate many of the RACS nontechnical skill competencies Methods: To quantify the impact of COVID-19 on surgical training, we completed a retrospective audit of the Urology Department activity during each Victorian pandemic wave in 2020 at our large regional teaching hospital. Corresponding weeks in the year prior were used as the control. Interviews with department members illustrated the adaptive approach to surgical training used at our institution. Results: A State of Disaster Surgical Triage Team (SODSTT) was established with surgical operations split between one public and two private hospitals in our region. A pandemic triaging protocol was established, and 335 Category-2 patients were re-triaged. All meetings were moved to online video conferencing formats. The first wave saw a 13.8% reduction in clinic reviews, with the second wave having an overall increase of 8.8% with 56% being telehealth. The second wave saw an 11.0% reduction in overall operating, with reduced emergency operating in both the first and second wave of 17.4% and 45.5% respectively. These reductions impacted surgical technical skill training, resulting in surgical education provided through technology platforms including webinars, podcasts and pre-recorded operative videos. The unique challenges trainees were faced with due to the pandemic encouraged development and expertise of the non-technical RACS competencies. Conclusions: We must reflect on the continual changes in our departments, considering the use of all educational opportunities and tools to ensure our trainees continue to develop and progress through their training, with particular focus on RACS competencies and non-technical skills.