key: cord-1045750-cl7s47wb
authors: English, W.; Vulliamy, P.; Banerjee, S.; Arya, S.
title: Surgical training during the COVID‐19 pandemic – the cloud with a silver lining?
date: 2020-07-14
journal: Br J Surg
DOI: 10.1002/bjs.11801
sha: 359cd7bf4694a453d687c75d2bd094bd718e03d0
doc_id: 1045750
cord_uid: cl7s47wb

nan

The COVID-19 pandemic has caused unprecedented disruption to global healthcare 1 . In the UK, planned operations, including the majority of cancer surgery, was discontinued at the start of April 2020 2 . In line with national guidance, rapid reconfiguration of emergency and elective surgical care has followed 3,4 . Doctors of all levels have been seconded to medicine and critical care; this has had a detrimental effect on training, especially within surgical specialties. General surgical training has not been immune to these necessary changes, anecdotally resulting in reduced operating frequency, procedure number and case type available to higher surgical trainees.

To understand this impact, we retrospectively interrogated operative logbooks of three higher surgical trainees from 1 April to 18 May 2020. Trainee experience level spanned the training pathway; surgical training year (ST) 4 (Trainee 1), 6 (Trainee 2) and 8 (Trainee 3).

There were 48 potential working days over this period. The number of shifts worked between trainees was comparable; Trainee 1: 23, Trainee 2: 23 and Trainee 3: 24. All worked a full-time, on-call rota including secondment periods to COVID-19 medical wards. No trainee was explicitly scheduled to cover the emergency (CEPOD) theatre over this period, although when working overnight they would be responsible for performing urgent operations with consultant input as necessary.

The total number of cases performed was 54 ( Hartmann's procedure Our experience shows that despite the significant changes to surgical services during the COVID-19 pandemic, the possibility of operative training remains. Due to the reduction in elective surgery and outpatient clinics, trainees have been deployed to duties that permit more flexible day-to-day working. As a result, within our unit, it has been possible for trainees to maintain some regular operating and training.

This unprecedented time has also allowed for training opportunities that would not otherwise be the norm. For example, the exclusive use of an open approach for appendicitis, which in our unit is usually reserved for children and adults unsuitable for laparoscopy. We recorded only one elective case among the training numbers. While some urgent cancer resections are taking place they are not always accessible to trainees with many units and specialist surgical societies until recently advising dual consultant operating only 6 .

COVID-19 is the defining global healthcare crisis of the modern era, unprecedented in scale and impact. There has been a measurable effect on training; less operating, more emergency driven case mix and a predominantly open approach. Although there has been the opportunity to operate, this is not a substitute for full-time training and we anticipate that this exceptional period will result in the majority of trainees having to extend their training. As the UK emerges from the first wave, it will be necessary to re-integrate trainees as quickly as possible into elective services to ensure that neither individual nor professional competency is adversely affected 7 . 

SARS-CoV-2)

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