The impact of COVID-19 on surgical training: a systematic review

Abstract

Background Coronavirus disease has caused global disruption to health care. Non-urgent elective surgical cases have been cancelled, outpatient clinics have reduced and there has been a reduction in the number of patients presenting as an emergency. These factors will drastically affect the training opportunities of surgical trainees. The aim of this systematic review is to describe the impact of COVID-19 on surgical training globally. Methods The review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched. Results The searches identified 499 articles, 29 of which were included in the review. This contained data from more than 20 countries with 5260 trainees and 339 programme directors. Redeployment to non-surgical roles varied across studies from 6% to 35.1%. According to all of the studies, operative experience has been reduced. Knowledge learning had been switched to online platforms across 17 of the studies and 7 reported trainees had increased time to devote to educational/ academic activities. All of the studies reporting on mental health report negative associations with increased stress, ranging from 54.9% to 91.6% of trainees. Conclusions The impact of COVID-19 on surgical trainees has been experienced globally and across all specialities. Negative effects are not limited to operative and clinical experience, but also the mental health and wellbeing of trainees. Delivery of surgical training will need to move away from traditional models of learning to ensure trainees are competent and well supported.

The Impact of COVID-19 on Surgical Training: the Past, the Present and the Future

“…Despite the potential introduction of bias, the ‘unanimous’ results from all the surveys strengthen the findings [ 19 , 21 – 29 ]. Also, in agreement is the demonstrated reduction of performed cases on the electronic logbook of trainees [ 63 ], which provides an ‘independent’ confirmation of the effect demonstrated in the surveys.…”

“…A great number of studies have reported a detrimental effect on surgical training. The majority of them described it ‘severe’ or ‘significant’ and some even ‘catastrophic’ [ 19 , 21 , 22 , 28 , 30 – 43 ]. These reports come both from developed [ 13 , 21 , 22 , 24 , 26 , 31 – 34 , 44 – 52 ] and developing countries [ 28 , 30 , 35 , 53 – 55 ] with very different healthcare systems.…”

“…The majority of them described it ‘severe’ or ‘significant’ and some even ‘catastrophic’ [ 19 , 21 , 22 , 28 , 30 – 43 ]. These reports come both from developed [ 13 , 21 , 22 , 24 , 26 , 31 – 34 , 44 – 52 ] and developing countries [ 28 , 30 , 35 , 53 – 55 ] with very different healthcare systems. Moreover, the results were uniform between a variety of surgical specialties; general surgery [ 13 , 19 , 21 , 30 , 32 , 34 , 37 , 41 , 42 , 44 , 47 , 56 , 57 ], orthopaedics [ 19 , 24 , 58 ], ENT (ear, nose, throat) surgery [ 19 , 31 , 50 ], vascular surgery [ 19 , 22 , 26 ], urology [ 22 , 26 , 53 ], oral and maxillofacial surgery [ 19 , 33 ], and neurosurgery [ 19 , 54 , 59 ].…”

“…Most of the evidence provided are extracted from surveys and editorials [ 19 , 21 – 29 ]. While most surveys have a decent response rate and a great number of responders [ 19 , 21 – 29 ], surveys are considered to provide low-level evidence [ 60 ]. There are several reasons for this.…”

“…At the same time, they have given space to new technologies, like telemedicine and platforms for webinars, to blossom [ 19 , 20 ]. Several studies have looked into the impact of COVID-19 on surgical training [ 19 , 21 – 29 ]. Here, the author will attempt a comprehensive summary of their findings.…”