The Subjective Causal Impact of COVID-19 on Graduate Medical Education and Recommendations for Bridging the Educational Gap: A Global Cross-sectional Study

Abstract

Background: COVID-19 generated a system-wide shock causing an unbalanced equilibrium be- tween producing adequately trained physicians and meeting extraordinary operational needs. Pre- vious studies report the experience of surgical residents during COVID-19 on a regional level. This study measures the learning losses causally associated with the re-deployment of highly special- ized medical professionals to the care of COVID-19 patients, while we systematically investigate proposed remedial strategies. Methods: We administered an online cross-sectional survey in 67 countries capturing training inputs (i.e., surgeries and seminars residents participated in) before and during the pandemic and retrieved residents’ expected learning outputs, career prospects and recommended remedial mea- sures for learning losses. We compared responses of residents working in (treatment group) and out (control group) of hospitals with COVID-19 patients. Results: The analysis included 432 plastic surgery residents who were in training during the pandemic. Most of the learning losses were found in COVID-19 hospitals with 37% and 16% loss of surgeries and seminars, respectively, per week. Moreover, 74%, 44%, and 55% of residents ex- pected their surgical skill, scientific knowledge, and overall competence, respectively, to be lower than those of residents who graduated prior to COVID. Residents in COVID-19 hospitals reported participating in significantly (p < 0.001) fewer surgeries and having significantly (p < 0.001) lower surgical skill relative to those not in COVID-19 hospitals. Conclusions: The perceived lower competence and the fall-off in surgical skill and scientific knowl- edge among future surgeons suggest that healthcare systems globally may have limited capacity to perform delicate and costly procedures in the future.