Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of 8 Programs

Abstract

Objective The objective was to determine the impact of the COVID-19 pandemic on operative case volume in 8 US neurosurgical residency training programs in early 2020 and to survey these programs regarding training activities during this period. Methods A retrospective review was conducted of monthly operative case volumes and types for 8 residency programs for 2019 and January-April 2020. Cases were grouped as elective cranial, elective spine, and non-elective emergent cases. Programs were surveyed regarding residents’ perceptions of the impact of COVID-19 on surgical training, didactics, and research participation. Data was analyzed for individual programs and pooled across programs. Results Across programs, the 2019 monthly case average was 211 (SD ± 82); 2020 average case volumes for January, February, March, and April were 228±93, 214±84, 180±73, and 107±45, respectively. Compared with 2019, March and April 2020 average cases declined 15% (p=0.003) and 49% (p=0.002), respectively. COVID-19 affected surgical case volume for all programs; 75% reported didactics negatively affected, and 90% reported COVID-19 resulted in increased research time. Several neurosurgery residents have required COVID-19 testing, however, to our knowledge, only one resident from the participating programs tested positive. Conclusions This study documents a significant reduction in operative volume in 8 neurosurgery residency training programs in early 2020. During this time, neurosurgery residents engaged in online didactics and research-related activities, reporting increased research productivity. Residency programs should collect data to determine the educational impact of the pandemic on resident operative case volumes, identify deficiencies, and develop plans to mitigate any effects.

In Reply to the Letter to the Editor Regarding “Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of Eight Programs”

“…Goyal et al 2 reported that 88.13% of their survey respondents indicated that the pandemic will have a negative impact on their operative and clinical skills, 2 whereas in our study, only 37.5% of the respondents had a similar response. 1 Some of the surveyed programs in our study have a high surgical case volume, which was evident in the pre-COVID-19 case numbers. 1 Also, the neurosurgery training in the United States has a predefined length of 84 months, which is longer than the neurosurgical training in India.…”

“… 1 Some of the surveyed programs in our study have a high surgical case volume, which was evident in the pre-COVID-19 case numbers. 1 Also, the neurosurgery training in the United States has a predefined length of 84 months, which is longer than the neurosurgical training in India. 6 Moreover, the nonurgent elective surgical procedures cancellation and postponement policies affected March and April 2020, and were followed by a gradual roll back of the restrictions that started in May 2020.…”

“…I would like to thank Goyal et al. for their interest in our study 1 concerning the early effects of COVID-19 pandemic on neurosurgical training in the United States. The study included a retrospective review of the monthly operative case volumes of 8 US neurosurgery residency programs for 2019 and January–April 2020.…”

“…The authors reported that approximately 50% of the surveyed residents were deployed to perform COVID-19-related activities, which was different from our findings in which none of the residents in the participating program were deployed to provide medical care for COVID-19 patients. 1 The difference could be due to selection bias, as the pandemic impacted different regions of the world and the United States with different severity. 3 Also, the social distancing protocols that were implemented in the United States, which slowed the spread of the infection, could have contributed to the difference.…”

“…reported that 75% of the their survey respondents observed a decline in research activities, whereas 87.5% of our survey respondents noticed an increase in the time available for research, and 62.5% observed an increase in academic productivity, represented by an increase in the number of written and or published abstracts and manuscripts. 1 In the United States, there are several types of research databases (institutional, public health, insurance carriers, etc.) that are available, with substantial amount of data.…”