key: cord-0795396-4e46dkrz authors: Ferrario, Luca; Maffioli, Anna; Bondurri, Andrea A.; Guerci, Claudio; Lazzarin, Francesco; Danelli, Piergiorgio title: COVID-19 and surgical training in Italy: Residents and young consultants perspectives from the battlefield date: 2020-06-01 journal: Am J Surg DOI: 10.1016/j.amjsurg.2020.05.036 sha: da187bb80383f124c9de423e3af12c35b594f2c7 doc_id: 795396 cord_uid: 4e46dkrz COVID-19 is seriously affecting Italy, putting the health system under extreme pressure. Training of medical students and residents is also suffering from this with the suspension of lectures and clinical rotations. What solutions have been taken to deal with the issue? Abstract 23 COVID-19 is seriously affecting Italy, putting the health system under extreme pressure. 24 Training of medical students and residents is also suffering from this with the suspension of 25 lectures and clinical rotations. What solutions have been taken to deal with the issue? 26 27 COVID-19 in Italy and how it is challenging the healthcare system 28 In the late December 2019 the first cases of SARS-CoV-2-related pneumonia were recorded 29 in Wuhan (China) . These numbers put the health system under 37 extreme pressure, especially in Lombardy, the most affected region: both intensive care and 38 ordinary beds were filled rapidly with COVID-19 patients, consequently the health system 39 was completely reorganized with wards converted to COVID-19 wards. The surgical 40 departments have been heavily involved in this reorganization leading to the suspension of the 41 surgical activity with the exception of emergencies and oncological elective activity 3 . 42 Similar measures have been taken in several countries and in some cases are particularly 43 restrictive (e.g in Maryland), so scientific societies are issuing guidelines, often disease-44 specific, in order to help surgeons to better plan surgical activity 4 . Also the admission of 45 patients to the surgical department has been completely revised: patients receive a telephone 46 triage before admission in order to look for any suspicious symptoms for COVID-19 (fever or 3 respiratory symptoms), moreover, when admitted, they are subjected to a nasopharyngeal 48 swab and chest x-ray, then are all hospitalized in a single room and only one visitor is allowed 49 with the obligation to wear a mask and gloves 3 . The surgical staff, due to contact with 50 patients and other healthcare workers, is an important vehicle of contagion within the hospital, 51 so the personnel is subjected to daily measurement of body temperature at the entrance and if 52 higher than 99,5°F or respiratory symptoms are present, the healthcare professional is placed 53 in quarantine and subjected to a swab for SARS-CoV-2. Similar organization has been 54 undertaken in several other countries in order to minimize the risk of contagion in hospital 55 facilities 5 . In addition to the lack of beds, another issue is the shortage of healthcare staff 56 • Weekly lessons are suspended, as well as seminars, workshops, practical courses (e.g. 84 suture courses, laparoscopic simulators, cadaver lab) and national and international 85 congresses; 86 • Normally in this period, between winter and summer holidays, most of the surgical 87 intervention are performed. The interruption of the elective activity heavily affects 88 resident's training, as the elective surgery are those that are most frequently conducted 89 by residents as first operator. This can lead to failure to achieve the minimum number 90 of interventions required to achieve surgical certification; 91 • Many residents have been recruited to non-surgical wards to assist in the management 92 of COVID patients, thus being excluded from surgical activity. 93 In addition to the problems related to training, the effect of the pandemic on health of trainees 94 and other healthcare workers must not be forgotten. From this point of view, the psychological 95 burden that operators have to face is significant: every day, despite our efforts, hundreds of 96 patients die from COVID-19 in Italy and this determines a sense of helplessness and 97 A Novel Coronavirus from Patients with Pneumonia in 140 Johns Hopkins COVID-19 Map COVID-19: How 144 can a department of general surgery survive in a pandemic? Surgery Elective surgery in the 147 time of COVID-19 Surgery during the COVID-19 pandemic: A 150 comprehensive overview and perioperative care Tales from the frontline: the colorectal battle against SARS. Color Dis Psychological status of medical workforce during the 155 COVID-19 pandemic: A cross-sectional study Considerations and Implications for Surgical Learners Using Technology to Maintain the Education 162 of Residents During the COVID-19 Pandemic frustration in addition to the fear of being infected and bring the disease into our families. 98This can lead, in the short and long term, to psychiatric diseases (anxiety disorder, post-99 traumatic stress disorder, depression) 7 and it is essential that healthcare workers are 100 addressed by providing professional support. Another important aspect is the private life of 101 trainees healthcare workers: those who are parents have a serious trouble given by the closure 102 of schools ordered by the Government to contain the contagion, as entrusting the children to 103 grandparents care could constitute an additional vehicle of infection putting older people at 104 serious risk. 105This situation also offers opportunities: residents employed in COVID departments 106 can acquire management skills for the critically ill 8 , which will be extremely valuable in 107 their future career, moreover, more free time given by reduced workload in the wards allows 108 trainees to have more time to study and update on scientific literature. The pandemic has significantly affected the life of us all, leading to a significant reduction in 132 our exposure to all training activities. We will only see in the future what consequences will 133 be on our training and how much these have been mitigated by solutions suggested. Now, 134 however, it is time to hold on despite the difficulties: we have a duty to continue offering care 135 to all to the best of our ability and, at the same time, to continue training to ensure the future 136 of the health system. 137 7 The authors declare that they have no conflict of interest. There is no source of funding.