COVID-19 and surgery: A thematic analysis of unintended consequences on performance, practice and surgical training

Abstract

Purpose The shift in the national focus and allocation of resources to the management of COVID19 has led to significant changes to surgical practice including the delay of elective surgery. The aim of this study was to explore the implications of such changes on surgeons. Method Using a qualitative study design, semi-structured interviews were conducted with general surgery consultants and non-consultant hospital doctors from a major tertiary hospital in the Dublin region between March–May 2020. Data collection proceeded iteratively using a thematic analysis approach with quality controls such as memoing and collaborative analysis. Results Fourteen surgeons (8 male, 6 female) were interviewed. The majority (n = 11, 78.6%) were NCHDs. Significant themes determined included ‘impacts’ on a variety of constructs such as performance, self-reported fatigue and wellbeing. Training themes elucidated included the effects of the cancellation of elective admissions on reduced operative exposure for trainees. Senior surgical staff were particularly focused on increased complexity in patient management. New policy requirements such as personal protective equipment use and novel rotas have had implications for aspects of work engagement. The pandemic and subsequent national restrictions imposed has afforded opportunities for improved well-being but also resulted in greater solitude in surgeons. Conclusions Rhetoric surrounding fatigue management and virus control dominates the conversation on the relationship between COVID-19 and surgery. Tipping the balance back to parity of fatigue management with service delivery in surgery will be key for sustainability of the surgical workforce.

Personal Protective Equipment in COVID-19

“…2 While wearing awkward and multi-layered protective gear, HCPs often experience difficulties in delivering a high level of care to patients; their performance may be impacted to a significant degree. 3 , 4 Each different manufactory and brand requires healthcare providers to follow different procedure in wearing. Non-compliance donning and doffing of PPE may lead to increasing chances of contamination.…”

Impact of the COVID-19 Pandemic on the Practice of Hand and Upper Extremity Surgeons

“…Other researchers have studied the effect of the pandemic on many different specialties such as orthopedic surgery, maxillofacial surgery, plastic surgery, minimal access surgery, and transplant surgery [6][7][8][9][10][11][12][13][14][15][16]. However, a comprehensive analysis of the effect of COVID-19 on hand surgery has not been done.…”

‘Overnight, things changed. Suddenly, we were in it’: a qualitative study exploring how surgical teams mitigated risks of COVID-19

“…This is supported by findings from interviews with 14 surgeons from a hospital in Ireland, which reported how COVID-19 had fundamentally impacted clinical roles and had consequences on wellbeing. 39 It has been argued that the surgical community needs to be provided with support to limit the inevitable psychological burden and risk of burnout. [40][41][42][43][44] Shanafelt and colleagues also emphasise that visible leadership is crucial during this turbulent time, and that leaders will need to establish innovative ways to engage with their teams to fully listen to and understand the sources of concern, and work with them to develop approaches that mitigate concerns.…”