key: cord-0858926-vdbevmkc authors: Jayatilaka, Malwattage Lara Tania; As-Sultany, Mohammed; Gabr, Ayman; Thornton, Luke; Graham, Simon; Mason, Lyndon; Farrar, Nicholas Greville title: Collaborative overview of CoronaVirus impact on ORTHopaedic training in the UK (COVI-ORTH UK) date: 2021-03-10 journal: Surgeon DOI: 10.1016/j.surge.2021.02.007 sha: 04f6b869f46cc1dac2cb4dfb9e3ada95c8cd3803 doc_id: 858926 cord_uid: vdbevmkc INTRODUCTION: COVID-19 was declared a pandemic by the World Health Organization on the 11th of March 2020 with the NHS deferring all non-urgent activity from the 15th of April 2020. The aim of our study was to assess the impact of COVID-19 on Trauma and Orthopaedic trainees nationally. METHODS: Trauma and Orthopaedic (T&O) specialty trainees nationally were asked to complete an electronic survey specifically on the impact of COVID-19 on their training. This UK based survey was conducted between May 2020 and July 2020. RESULTS: A total of 185 out of 975 (19%) T&O specialty trainees completed the survey. Redeployment was experienced by 25% of trainees. 84% of respondents had experienced a fall in total operating numbers in comparison with the same time period in 2019. 89% experienced a fall in elective operating and 63% experienced a fall in trauma operating. The pandemic has also had an effect on the delivery of teaching, with face to face teaching being replaced by webinar-based teaching. 63% of training programmes delivered regular weekly teaching, whilst 19% provided infrequent sessions and 11% provided no teaching. CONCLUSION: This study has objectively demonstrated the significant impact of the COVID-19 pandemic on all aspects of T&O training. In addition to changes to provision of trauma care and cessation of elective surgery, all non-72 essential face-to-face clinic appointments were cancelled 4 . This led to the utilisation of 73 remote consultations, particularly in elective practice. Significant work is required in order 74 to ensure the clinical safety and patient satisfaction of these consultation methods when 75 widening their scope 5 . As well as redeployment to other specialties, consultant and junior 76 rotas were redesigned. This included rostering shifts in dedicated minor injuries units or the 77 Emergency Department. Further, a proportion of trainees were often requested to stay at 78 home on 'ghost rotas' to ensure resilience with the threat of personnel loss 6 . 79 The impact of COVID-19 for all surgical trainees will be felt not only in the UK, but across the 81 globe 7 . In the UK, the extent and regional variability of loss of training remains unclear. 82 Furthermore, the number of redeployed to other specialties, such as intensive care and 83 internal medicine, is unknown. The above will have an inevitable impact on trainees ability Armonk, NY, USA). Demographic data were presented descriptively. Categorical variables 105 were described as proportions and continuous variables were presented as medians and 106 interquartile ranges. The statistical relationship between categorical variables was assessed 107 using a chi-squared test. The Shapiro-Wilk test was used to assess for data normality. For 108 continuous data, the Student's t-test was used when the numerical values for the two 109 independent groups were normally distributed, otherwise the Mann-Whitney U test was 110 used when normal distribution was not achieved. Significance was set at a p-value < 0.05. 111 Demographics 114 A total of 185 T&O specialty trainee level 1 to 8 (ST1-ST8) trainees from all training regions 115 across the UK completed the online survey (Table 1) Table 2, 143 there was a 49%, 79% and 25% overall reduction in the median number of total, elective 144 and trauma operative cases respectively compared to March-April 2019. J o u r n a l P r e -p r o o f study, is a great cause for concern. The uncertainty around the variable pace of re-208 establishment of elective activity across different NHS trusts, makes it difficult to predict 209 whether trainees will be able to achieve this total number during their orthopaedic training. 210 We used the results from this study to build a predictive model to determine whether 211 trainees would be able to achieve this target within their expected CCT date. We considered 212 resuming full elective activities in August 2020 as the best-case scenario, while the worst-213 case scenario was resuming full elective activities in August 2021. Based on this model, it is 214 anticipated that trainees will not be able to achieve the 1800 operative cases in their 6 years 215 of training. Moreover, they are likely to be short of 150 cases if full elective activity were 216 only resumed in August 2021 (Fig.2) . This worst-case scenario indicates that trainees are 217 likely to require an extra 6 month of training to achieve their target of 1800 surgical cases. 218 Therefore, the new ARCP outcomes created by the UK training committees appear to be 219 correct at this time. 220 221 Teaching is an important and essential part of T&O training with training programmes 222 across the country delivering weekly teaching. In order to reduce face to face interactions 223 and adhere to social distancing regulations, training programmes nationally have tried to 224 continue teaching with 63% of them delivering regular weekly webinar-based sessions. The 225 quality of this teaching was rated as very good and good by 76% of the respondents. A 226 number of authors have suggested that remote learning is likely to remain in the post-227 COVID era, due to benefits such as reduced cost, reduced need for travel (as trainees are 228 spread over a wide area) and the opportunity to record lectures 16,17 . This effect been seen 229 Worldwide where it has created new opportunities for learning delivery and professional 230 J o u r n a l P r e -p r o o f growth and demonstrates how quickly the Orthopaedic community adapted to these rapid 231 unprecedented changes caused by the pandemic 18 (blue) and face-to-face elective clinics (orange) were stopped in relation to the 15 th April 367 2020. 368 Table 3 -ARCP outcomes Outcome 1 Satisfactory Progress -achieving progress and the development of competences at the expected rate. This is subject to successful completion of the training period. Development of specific competences required -additional training time not required. Outcome 3 Inadequate progress -additional training time required. Outcome 4 Released from training programme -with or without specified competences. Outcome 5 Incomplete evidence presented -additional training time may be required. Gained all required competences -will be recommended as having completed the training programme and for award of a CCT or CESR/CEGPR. Outcome 7.1 Satisfactory progress in or completion of LAT placement. Outcome 9 Doctors undertaking top up training in a training post. Outcome 10.1 Progress is satisfactory but the acquisition of competences/capabilities by the trainee has been delayed by COVID-19 disruption. The trainee is not at a critical progression point in their programme and can progress to the next stage of their training. Any additional training time will be reviewed at the next ARCP. Outcome 10.2 Progress is satisfactory but the acquisition of competences/capabilities by the trainee has been delayed by COVID-19 disruption. The trainee is at a critical progression point in their programme and additional training time is required. 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