Perceived Impact of Urologic Surgery Training Program Modifications due to COVID-19 in the United States

Abstract

To assess urology residency program modifications in the context of COVID-19, and perceptions of the impact on urology trainees. METHODSA cross-sectional survey of program leadership and residents at accredited US urology residencies was administered between April 28, 2020 to March 11, 2020. Total cohort responses are reported, and subanalyses were preformed comparing responses between those in in high vs low COVID-19 geographic regions, and between program leaders vs residents. RESULTSProgram leaders from 43% of programs and residents from 18% of programs responded. Respondents reported decreased surgical volume (83%-100% varying by subspecialty), increased use of telehealth (99%), a transition to virtual educational platforms (95%) and decreased size of inpatient resident teams (90%). Most residents are participating in care of COVID-19 patients (83%) and 20% endorsed that urology residents have been re-deployed. Seventy nine percent of respondents perceive a negative impact of recent events on urology surgery training and anxiety regarding competency upon completion of residency training was more pronounced among respondents in high COVID-19 regions. CONCLUSIONMajor modifications to urology training programs were implemented in response to COVID-19. Attention must be paid to the downstream effects of the training disruption on urology residents.

COVID-19 Pandemic and the Lived Experience of Surgical Residents, Fellows, and Early-Career Surgeons in the American College of Surgeons

“…In this survey of residents and early-career surgeons in the American College of Surgeons, respondents generally felt that the COVID-19 pandemic had negative effects on their clinical experience. These results have been echoed in other studies of trainees from surgical trainees in programs based in the United States ( 14 , 15 , 16 ) and outside of the United States(17-20), citing concerns about severe reduction in training exposure(17-20), including decreased operative volume(14), and anxiety about a potential required extension of training due to inability to meet operative requirements for graduation(15, 16, 18). Additionally, not only has a reduction in formalized educational programming for trainees been reported, but on some surveys, residents have reported decreased satisfaction with virtual education programming(21).…”

Impact of CoVID-19 on resident and fellow education: Current guidance and future opportunities for urologic oncology training programs

“…An estimated 90% of programs created rotating skeleton crews to ensure a healthy reserve of residents, while others organized distinct teams for operating and floor care. [9] , [10] , [11] , [12] To further limit patient-provider contact, some programs performed virtual sign-outs and discouraged team rounds, designating patient rounding assignments to individual team members. [9] Many urology residents were instructed to assess consults via telemedicine or recommend outpatient follow-up for routine inpatient urology consults.…”

“… [13] Approximately 83% of residents report involvement with CoVID-19 patients while on a urology service, which presents an ethical dilemma. [ 10 , 13 ] Because of their relatively small size, many urology programs may not have the infrastructure to divide residents, fellows, and advanced practice providers into “clean” (non-CoVID-19) and CoVID-19 positive teams. To our knowledge, there are no published protocols within urologic literature regarding how to manage these mixed teams in order to protect other team members as well as immunocompromised oncology patients.…”

“…Urology residency program leaders reported surgical volumes decreased between 83-100% across urologic subspecialties. [10] …”

COVID-19 and the urological practice: changes and future perspectives

“…The COVID-19 pandemic has caused a substantial decrease in assistance and academic activities in most medical residences, affecting urological residents too. The deprivation and difficulties in training were commonly reported in many countries [ 17 , 18 , 19 ]. The loss of clinical routine and daily activities, the cancellation of external internships, exams and numerous events, such as congresses, has impacted negatively on the annual planning for the specialization.…”