Impact of the COVID-19 pandemic on urology residency training in Italy

Amparore, Daniele; Claps, Francesco; Cacciamani, Giovanni; Esperto, Francesco; Fiori, Cristian; Liguori, Giovanni; Serni, Sergio; Trombetta, Carlo; Carini, Marco; Porpiglia, Francesco; Checcucci, Enrico; Campi, Riccardo

doi:10.23736/s0393-2249.20.03868-0

Cited by 188 publications

(146 citation statements)

References 7 publications

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“…10 In Italy, COVID-19 has been shown to have a detrimental effect on the training of Urology registrars, with a significant reduction in clinical and surgical exposure. 11 In the UK, normal training rotations have been suspended. There are few elective surgical theatre lists or clinics.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on core surgical training

et al. 2020

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Background and aims COVID-19 pandemic has caused significant disruption in training which is even more pronounced in the surgical specialties. We aim to assess the impact of COVID-19 pandemic on core surgical training. Methods All core surgical and improving surgical trainees in West of Scotland region were invited to participate in an online voluntary anonymous survey via SurveyMonkey. Results 28 of 44 (63.6%) trainees responded, 15 (53.6%) were CT1/ST1. 14 (50.0%) working in teaching hospital and 15 (53.6%) working in general surgery. 20 (71.4%) felt that due to the pandemic they have less opportunity to operate as the primary surgeon. 21 (75.0%) have not attended any outpatient clinics. 8 (28.6%) did not have any form of access to the laparoscopic box-trainer. 20 (71.4%) felt their level of confidence in preforming surgical skills has been negatively impacted. 18 (64.3%) found it difficult to demonstrate progress in portfolio. 21 (75.0%) trainees have not attended any teaching. 10 (35.7%) trainees have been off-sick. 8 (28.6%) trainees have felt slightly or significantly more stressed. Conclusion COVID-19 pandemic has an unprecedented negative impact on all aspects of core surgical training. The long term impact on the current cohort of trainees is yet to be seen.

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Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on core surgical training

et al. 2020

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“…Recent Italian experience in the COVID-19 era, based on a survey with 25 items sent to urology residents, suggests a severe reduction or complete suppression of clinical and surgical activity. The proportion of residents that experienced a severe/complete reduction of training ranged from 41.1% to 81.2% (12). The pandemic could be even the cause of different diagnostic and therapeutic strategies for minimizing the potential exposure of patients to hospitals, postponing low-risk surgeries, and delaying or reconsidering certain therapies (13).…”

Section: Discussionmentioning

confidence: 99%

“…Porpiglia et al suggested an online dedicated platform offering videos of lessons and surgical procedures or webinar meetings. Social media, podcasts and blogs could be another tool to create a network to implement our knowledge (11,12). Such "cognitive training" might allow users to rehearse a procedure without carrying it out, offering a relative advantage while not necessitating electronic resources or particular costs or fees.…”

Section: Discussionmentioning

confidence: 99%

How Can the COVID-19 Pandemic Lead to Positive Changes in Urology Residency?

Busetto

Giudice²,

Mari

et al. 2020

Front. Surg.

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The COVID-19 outbreak, in a few weeks, overloaded Italian hospitals, and the majority of medical procedures were postponed. During the pandemic, with hospital reorganization, clinical and learning activities performed by residents suffered a forced remodulation. The objective of this study is to investigate how urology training in Italy has been affected during the COVID-19 era. In this multi-academic study, we compared residents' training during the highest outbreak level with their previous activity. Overall 387 (67.1%) of the 577 Italian Urology residents participated in a 72-h anonymous online survey with 36 items sent via email. The main outcomes were clinical/surgical activities, social distancing, distance learning, and telemedicine. Clinical and learning activity was significantly reduced for the overall group, and after categorizing residents as those working only in COVID hospitals, both “junior” and “senior” residents, and those working in any of three geographical areas created (Italian regions were clustered in three major zones according to the prevalence of COVID-19). A significant decrease in outpatient activity, invasive diagnostic procedures, and endoscopic and major surgeries was reported. Through multivariate analysis, the specific year of residency has been found to be an independent predictor for all response modification. Being in zone 3 and zone 2 and having “senior” resident status were independent predictors associated with a lower reduction of the clinical and learning activity. Working in a COVID hospital and having “senior” resident status were independent predictors associated with higher reduction of the outpatient activity. Working in zone 3 and having “senior” resident status were independent predictors of lower and higher outpatient surgical activity, respectively. Working in a COVID hospital was an independent predictor associated with robotic surgical activity. The majority of residents reported that distance teaching and multidisciplinary virtual meetings are still not used, and 44.8% reported that their relationships with colleagues decreased. The COVID-19 pandemic presents an unprecedented challenge, including changes in the training and education of urology residents. The COVID era can offer an opportunity to balance and implement innovative solutions that can bridge the educational gap and can be part of future urology training.

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“…Five studies examined the impact of changes to surgical services among physicians and trainees, and found that training was compromised in some specialties. [18][19][20][21] The finding that medical training was compromised is particularly important for understanding the downstream and long-term repercussions of the response to public health emergencies; decreases in surgical volumes and clinical hours for trainees could have negative and unintended effects on the future quality and safety of patient care. 42 Studies examining the effects of surgical service alterations on patients noted negative effects on mental health outcomes, 27 28 pain, 27 and an increased incidence of death among surgical patients.…”

Section: Discussionmentioning

confidence: 99%

“…17 Changes in Resident/Fellow Involvement in Surgical Activities. Four studies [18][19][20][21] reported on this outcome; two survey-based case series, one resident-level case study and one study containing both survey and case log data. The reductions in surgical involvement for residents are shown by quartile in Figure 3b.…”

Section: Impact Of Reorganizing Surgical Servicesmentioning

confidence: 99%

Surgery & COVID-19: A rapid scoping review of the impact of COVID-19 on surgical services during public health emergencies

O'Rielly

Ng‐Kamstra

Kania-Richmond

et al. 2020

Preprint

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BackgroundHealthcare systems globally have been challenged by the COVID-19 pandemic, necessitating the reorganization of surgical services to free capacity within healthcare systems.ObjectivesTo understand how surgical services have been reorganized during and following public health emergencies, and the consequences of these changes for patients, healthcare providers and healthcare systems.MethodsThis rapid scoping review searched academic databases and grey literature sources to identify studies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems. Recommendations and guidelines were excluded. Screening was completed in partial (title, abstract) or complete (full text) duplicate following pilot reviews of 50 articles to ensure reliable application of eligibility criteria.ResultsOne hundred and thirty-two studies were included in this review; 111 described reorganization of surgical services, 55 described the consequences of reorganizing surgical services and six reported actions taken to rebuild surgical capacity in public health emergencies. Reorganizations of surgical services were grouped under six domains: case selection/triage, PPE regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganizations led to large reductions in non-urgent surgical volumes, increases in surgical wait times, and impacted medical training (i.e., reduced case involvement) and patient outcomes (e.g., increases in pain). Strategies for rebuilding surgical capacity were scarce, but focused on the availability of staff, PPE, and patient readiness for surgery as key factors to consider before resuming services.ConclusionsReorganization of surgical services in response to public health emergencies appears to be context-dependent and has far-reaching consequences that must be better understood in order to optimize future health system responses to public health emergencies.ARTICLE SUMMARYStrengths and limitations of the studyThis rapid scoping review provides an exhaustive and rigorous summary of the academic and grey literature regarding modifications to surgical services in response to public health emergencies, especially COVID-19.This study did not limit studies based on location or language of publication to ensure a worldwide pandemic had contributions from worldwide voices.Both quantitative and qualitative outcomes were included, with a mix of inductive and deductive data abstraction approaches to provide a comprehensive understanding of surgical services during public health emergencies.Studies with potential relevance to this question are emerging at an unprecedented rate in response to the COVID-19 pandemic and as such, some may not be included in the current review.Original protocol for the studyAs requested, the original unpublished protocol for this study is included as a supplementary file.Funding statementThis study did not receive grant from any funding agency in the public, commercial or not-for-profit sectors.Competing interest statementAll authors declare that they have no competing interests in accordance with the International Committee of Medical Journal Editors uniform declaration of competing interests.

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Impact of the COVID-19 pandemic on urology residency training in Italy

Cited by 188 publications

References 7 publications

Impact of the COVID-19 pandemic on core surgical training

Impact of the COVID-19 pandemic on core surgical training

How Can the COVID-19 Pandemic Lead to Positive Changes in Urology Residency?

Surgery & COVID-19: A rapid scoping review of the impact of COVID-19 on surgical services during public health emergencies

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