key: cord-0994592-dc5gthyx authors: Smood, Benjamin; Spratt, John R.; Mehaffey, J. Hunter; Luc, Jessica G. Y.; Vinck, Eric E.; Lehtinen, Miia L.; Wallen, Tyler J.; Jenkinson, Charles G.; Kim, Woojung; Kesieme, Emeka B.; Han, Jason J.; Helmers, Mark R.; Iyengar, Amit; Patrick, William L.; Kelly, John J.; Watkins, Ammara A.; Cevasco, Marisa; Williams, Matthew L. title: COVID‐19 and cardiothoracic surgery: Effects on training and workforce utilization in a global pandemic date: 2021-06-25 journal: J Card Surg DOI: 10.1111/jocs.15773 sha: 27a641dadbda4e11056877b9a33d5988ba5e22df doc_id: 994592 cord_uid: dc5gthyx BACKGROUND: The COVID‐19 pandemic has disrupted all aspects of healthcare, including cardiothoracic surgery (CTS). We sought to determine the pandemic's impact on CTS trainees' educational experiences. METHODS: A survey was developed and distributed to members of the Thoracic Surgery Residents Association and other international CTS trainees. Trainees were asked to evaluate their cumulative experiences and share their overall perceptions of how CTS training had been impacted during the earliest months of the COVID‐19 pandemic (i.e., since March 01, 2020). Surveys were distributed and responses were recorded June 25–August 05, 2020. In total, 748 surveys were distributed and 166 responses were received (overall response rate 22.2%). Of these, 126 of 166 responses (75.9%) met inclusion criteria for final analysis. RESULTS: Final responses analyzed included 45 of 126 (35.7%) United States (US) and 81 of 126 (64.3%) international trainees, including 101 of 126 (80.2%) senior and 25 of 126 (19.8%) junior trainees. Most respondents (76/126, 43.2%) lost over 1 week in the hospital due to the pandemic. Juniors (12/25, 48.0%) were more likely than seniors (20/101, 19.8%) to be reassigned to COVID‐19‐specific units (p < .01). Half of trainees (63/126) reported their case volumes were reduced by over 50%. US trainees (42/45, 93.3%) were more likely than international trainees (58/81, 71.6%) to report reduced operative case volumes (p < .01). Most trainees (104/126, 83%) believed their overall clinical acumen was not adversely impacted by the pandemic. CONCLUSIONS: CTS trainees in the United States and abroad have been significantly impacted by the COVID‐19 pandemic, with time lost in the hospital, decreased operative experiences, less time on CTS services, and frequent reassignment to COVID‐19‐specific care settings. Only respondents who reported active enrollment in a dedicated CTS training program as of March 1, 2020 who also completed 100% of the survey were included in the final analysis. Respondents who reported enrollment in a CTS program in the United States were considered "United States" trainees, regardless of nationality. CTS trainees enrolled in programs outside the United States were analyzed collectively as "international" trainees. SMOOD ET AL. Trainees who completed other surgical training before their CTS training (i.e., traditional/advanced CTS fellows) as well as integrated CTS residents (e.g., integrated 6-year residencies, 4 + 3 Joint Thoracic/General surgery residencies, or similar programs) in at least their fourth post-graduate year (PGY) of training were considered "senior" trainees. Integrated residents who were PGY ≤ 3 were considered "junior" trainees. The survey defined CTS-related rotations as adult cardiac surgery, general thoracic surgery, congenital CTS, and nonoperative CTSrelated rotations (i.e., cardiology, oncology, imaging, etc.). CTS trainees who reported being reassigned to work in drive-thru or off-site COVID-19 testing stations, COVID-19-specific wards (i.e., intensive care units, makeshift wards, etc.), procedure teams (i.e., on-call placement of central lines, chest tubes, etc.), and those who completed unanticipated emergency department rotations during the pandemic were considered to have been redeployed to COVID-19-specific units. Most respondents (82/126, 65.1%) reported that they lost inpatient clinical time as a result of the pandemic due to staffing/scheduling changes and/or quarantines related to illness or exposure. Approximately half of respondents (67/126, 53.2%) indicated that they were removed from clinical duties for more than 1 week and 18 of 126 (14.3%) trainees were absent for more than 4 weeks ( Figure 2 ). The majority of respondents (91/126, 72.2%) reported that they were removed from or got less exposure to CTS-related rotations than they had anticipated before the COVID-19 pandemic ( (Table 2) . Although only a minority of trainees (28/126, 22.2%) had interviews for additional training or jobs scheduled during the earliest months of the COVID-19 pandemic, those who did often had interviews delayed or rescheduled (16/28, 57.1%) and even canceled (9/28, 32.1%). Some trainees completed interviews virtually (8/28, 28.6%), but in-person interviews were rare (2/28, 7.1%). The majority of trainees believed that their programs sufficiently prepared them for the pandemic ( .820 Expect to be unable to meet, or increased concern regarding ability to meet training/graduation requirements Despite these unanticipated disruptions, most trainees did not believe that their overall clinical (i.e., nonoperative) acumen had been adversely affected by the pandemic, and fewer than half expressed T A B L E 5 Comments from cardiothoracic surgery trainees regarding the effects of the COVID-19 pandemic on their education I will probably meet my case requirement, but things are just now getting really bad where I train. COVID-19 has substantially harmed my quality of training in ways not captured in this survey. I could not complete my procurement numbers as COVID-19 restricted recoveries. I really miss the wealth of knowledge that we enjoyed receiving from our senior colleagues. COVID-19 has negatively affected cardiothoracic surgical training by reducing theater staff strength, especially after exposure to a COVID-19 positive patient. I am losing valuable time in the operating room that would allow me to fine tune operative decision making, which I feel at times is more important than being able to suture. The reduction in my case load has been significant. There has been an increase in call duties resulting from a decrease in available house staff. Online conferences and increased research productivity have actually been beneficial. We were denied from learning all airway procedures in the intensive care unit, even among patients without COVID-19. concerns about potential extensions in their training or delays in their graduation. Nevertheless, our results suggest that these concerns were significantly more common among international trainees (~50%) than US trainees (~20%). For comparison, Caruana et al. 5 found that nearly 90% of CTS trainees in the United Kingdom worried about how the COVID-19 pandemic would ultimately impact their education, with 71% citing specific concerns about the possibility of having to extend their training. The relative lack of concern among US trainees is somewhat surprising, but could reflect the degree to which CTS trainees felt It must be underscored that this investigation does not quantify the impact of the COVID-19 pandemic on all CTS trainees worldwide. Despite substantial efforts to distribute the survey to international trainees through official CTS trainee organizations around the globe, some organizations were unable to formally administer the survey to all of their trainees and many countries lacked such organizations. Therefore, the study's sample group was largely driven by TSRA membership. Although the response rate was consistent with other recent surveys by the TSRA, 15 it was relatively low (~22%) and does not reflect responses received from social media interactions, which could skew the survey response rate. Additionally, our attempts to capture the cumulative perceptions and overall experiences of CTS trainees during the earliest months of the pandemic did not account for regional and/or time-specific variations in cases of COVID-19. 1 As such, response biases likely exist in the data. It must also be recognized that there are significant differences in CTS training programs both around the world and within the United States. 16 Therefore, although the limited sample size of our study population precluded further regional analyses of CTS trainees, this should be a focus of future investigations. As such, additional studies aiming to improve CTS training and education around the globe could benefit from the development of other national and/or regional CTS trainee organizations, for which this investigation provides an important step in fostering further national and international collaborations among CTS trainees. 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