The impact of the first wave of the COVID-19 pandemic on the exposure of general surgery trainees to operative procedures

Abstract

Introduction During the COVID-19 pandemic, the redeployment of operating room (OR) staff resulted in a significant ramp-down of elective surgery. To mitigate the negative effects of the pandemic on surgical education, this study was planned to estimate the impact of the first wave of the pandemic on the participation of general surgery residency and fellowship trainees in operative procedures. Methods This study is a retrospective review of all adult general surgery procedures performed at 3 sites of an academic health care network. Cases performed during the first wave of the pandemic (March–June 2020) were compared to the same period of the previous year pre-pandemic (March–June 2019). Trainees were categorized as junior (Post-Graduate-Year [PGY] 1–2), senior (PGY3-5), or fellows (PGY6-7). Operating exposure was defined as (1) the total number of cases attended by at least one trainee and (2) total time spent in the OR by all trainees (hours). The impact of the pandemic was estimated as percentage of baseline (2019). Results During the first wave of the pandemic, a total of 914 cases were performed, compared to 1328 in the pre-pandemic period (69%). Junior trainees were more affected than senior trainees with reductions in both case volume (68% versus 78% of baseline attendance) and time (68% versus 77% of baseline operating time). Minimally invasive surgery fellows were most severely affected trainees and colorectal fellows were least affected (14% and 75% of baseline cases, respectively). Participation in emergency surgery cases and surgical oncology cases was relatively preserved (87% and 105% of baseline, respectively). Conclusions The first wave of the COVID-19 pandemic reduced operative exposure for general surgery trainees by approximately 30%. Procedure-specific patterns reflected institutional policies for prioritizing cancer operations and emergency surgeries. These findings may inform the design of remediation activities to mitigate the impact of the pandemic on surgical training.

General Surgery Trainee Cases Over Time: Postgraduate Year Matters

“…One study showed an overall decrease in resident cases 26 and another showed a decrease in certain subsets of cases with differences based on resident year. 27 Double scrubbing, either with the junior resident as a first assistant or the senior resident/fellow as a teaching assistant, while not a replacement for cases in which a trainee is operating with the attending alone, may have added importance as an adjunct in temporary or permanent times of decreased volume for all or certain cases or for rarer cases.…”

Trends in Medicare Part B procedural services performed by dermatology trainees during the COVID-19 pandemic

“…Similar declines have been demonstrated among general surgery trainees, although predominately for elective (nononcology) cases. 4 Enhanced safety measures, personal protective equipment shortages, and COVID-19 testing capabilities may have all contributed to decreased volume. The explanation for regional differences is unclear, yet areas with greater declines in 2020 tended to have higher baseline per-trainee procedural volume.…”