key: cord-302859-dc26tyu2
authors: Zahid, Marij; Ali, Arif; Baloch, Naveed Jumman; Noordin, Shahryar
title: Effects of coronavirus (COVID-19) pandemic on orthopedic residency program in the seventh largest city of the world: Recommendations from a resource-constrained setting
date: 2020-06-25
journal: Ann Med Surg (Lond)
DOI: 10.1016/j.amsu.2020.06.026
sha: 
doc_id: 302859
cord_uid: dc26tyu2

The coronavirus (COVID-19) pandemic has hit the entire world hard. Since its inception from Wuhan China the whole world is affected now. Health care facilities and workers are overwhelmed and the situation is changing on daily basis. With the changes in the dynamics of the hospitals, residency and fellowships training programs have also suffered undoubtedly. Due to decreased elective cases and outpatient clinics surgical training gets compromised, however on the other side this physical distancing and isolation have proven to be effective measures in controlling the disease. In this article we share our experience of effect of COVID-19 pandemic on our orthopedic residency program and how we coped along with it. We also discussed some way forwards in the article.

seventh largest city of the world: Recommendations from a resource-constrained setting. 2 Abstract: 3 The coronavirus (COVID-19) pandemic has hit the entire world hard. Since its inception from 4 Wuhan China the whole world is affected now. Health care facilities and workers are 5 overwhelmed and the situation is changing on daily basis. With the changes in the dynamics of 6 the hospitals, residency and fellowships training programs have also suffered undoubtedly. Due 7 to decreased elective cases and outpatient clinics surgical training gets compromised, however 8 on the other side this physical distancing and isolation have proven to be effective measures in 9 controlling the disease. In this article we share our experience of effect of COVID-19 pandemic 10 on our orthopedic residency program and how we coped along with it. We also discussed some 11 way forwards in the article 12 Keywords: 13 Coronavirus; quarantine; orthopedic surgeons; pandemics; medical education 14 2 Introduction: 15 Since the inception of novel coronavirus in Wuhan, China, the global situation has changed 16 dramatically in every sector of life. The changes are dynamic and constantly evolving, even more 17 so as our country has not yet reached the peak, as we were quick to learn and implement social 18 distancing from the world. Furthermore, our government has been following the process of 19 screen, test and quarantine for confirmed cases which has resulted in containing the disease. In 20 the beginning of March 2020, Pakistan sealed its borders with China, Iran and Afghanistan and 21 international arrivals through flights were also curtailed as our airports were closed. Our hospital 22 diagnosed the first COVID-19 PCR positive case in the country on February 26 who was a 23 student returned from Iran [1] . Our section of Orthopedic Surgery was the first in our tertiary care 24 hospital to cut down outpatient clinic numbers by restricting practice to only "must be seen" 25 follow-up patients especially who have underwent surgery in prior weeks and so on, even before 26 our University hospital published their guidelines. As of morning of May 17, total corona virus 27 cases in Pakistan are 40,151 with 873 mortalities [1] . The city of Karachi, where our tertiary care 28 hospital is located is in lock down since March 23, which as per the last government 29 announcement was switched to a smart lockdown (re-opening of some semi-essential sectors) on 30 May 11.

The two vital practices of "social distancing" and "quarantine" have been key to control the 32 situation both in our community and hospital setup [2] . Health care workers being at the front line 33 are more likely to contract the virus due to the current pandemic; yet it is also important to 34 maintain a healthy resident workforce to sustain the ongoing patient care. As orthopedic 35 surgeons are not the usual front line health care providers, adapting to these protective practices 36 in our day to day inpatient and outpatient clinical work faced us with several challenges. 37 Various practices have been adopted by the hospitals worldwide to fight this issue which patient assessment and surgical hands on skills [3] . In the few past months, the surgical residency 44 3 program has suffered a lot worldwide in terms of suspension of elective cases as a sequelae of 45 succumbing to a lower patient load [4] . Despite the lower patient surgical hands on for residents 46 however, this pandemic has a brighter side in that it has opened multiple positive avenues and 47 learning opportunities for residents that were never explored before. It is still unpredictable when 48 this pandemic will be under control and the situation slowly normalizes. Will there be a second 49 peak and how badly would it hurt? Everyone is currently living in such ambiguity. We in this 50 article share our experience of orthopedic residency program in an urban tertiary care center and 51 delineate our division of work force during this pandemic and propose few recommendations. Education. Currently we are in the upsurge phase of the pandemic and different mathematical 136 models have projected that we may see the peak in the next two months, depending upon which 137 model is considered. If this pandemic turns into an endemic in our part of the world in the near 138 future, then we should be able to accommodate for the time lost, otherwise strategies such as 139 increasing the duration of the residency program may have to be considered. This approach 140 would seems to be essential to make up for loss of resident hands on and clinical experience 141 before they step into their surgical career, in order to ensure we graduate safe and appropriately 142 trained surgeons from the program.

Despite of decreased clinical work, our hospital has not resorted to layoffs and furloughs. 77% 144 bedside care staff will not take any pay cuts. Senior level faculty and staff including management 145 will have pay cuts that have been announced for three months with review thereafter. This has 146 allowed us to manage our workforce and set policies in place to ensure we hit the road running 

Quarantine Role in the Control of Corona Virus 166 in the World and Its Impact on the World Economy

Residency and Fellowship Program Accreditation: Effects of the Novel

COVID-19) Pandemic

Strategic planning and recommendations for 172 healthcare workers during the COVID-19 pandemic