Impact of the COVID-19 pandemic on Otolaryngology trainee education

Impact of COVID-19 pandemic on surgical training in the United States

The impact of the coronavirus disease COVID-19 pandemic on surgical training in the United States remains a controversial topic. In this study, we examined resident and fellow operative volumes in the pre-COVID-19 and COVID-19 periods across ten different surgical specialties. Accreditation Council for Graduate Medical Education (ACGME) national data reports were collected for ten surgical specialties, including general surgery, neurological surgery, ophthalmology, orthopedic surgery, pediatric surgery, plastic surgery (independent), thoracic surgery, urology, vascular surgery (integrated), and vascular surgery (traditional). Operative volumes were compared between graduates from the pre-COVID-19 (2013-2019) and COVID-19 (2020-2022) periods. Linear regression analysis was used to calculate trends in operative volume. Surgical residents and fellows graduating during the COVID-19 pandemic have greater or similar case volumes, when compared with graduates from the pre-pandemic period. These data suggest that surgical training in the United States has not been compromised by COVID-19 with regard to operative experience.

Medical students' perspectives on how COVID-19 has impacted their otolaryngology educational experience: A nationwide survey study

OBJECTIVES

To evaluate how medical students perceive COVID-19 has impacted various otolaryngology educational experiences and appreciate useful adaptations/resources that can be implemented moving forward.

METHODS

We circulated a web-based questionnaire among pre-clinical/clinical medical students. Participants were asked to rate their experiences in the realms of research, clinical exposure, faculty interaction, interest group (IG) activities, advising, and USMLE preparation considering the COVID-19 pandemic. Qualitative responses were mapped into thematic domains.

RESULTS

Completed responses from 201 medical students demonstrated an effect across all educational activities. Pre-clinical students experienced a negative impact on their IG involvement (77%; 86/111) and clinical students reported a diminished clinical experience (60%; 40/67), with 54% (36/67) citing below-expectation surgical exposure. Overall, 51% (90/178) of students reported a perceived decrease in beneficial otolaryngology career advising, decreased research involvement (57%, 101/178), and reduced faculty interaction (79%, 141/178). Faculty mentorship programs, curated video resources, and online question banks were selected as valuable resources during COVID-19 (21%, 20%, and 13% of selections, respectively) that may offer ongoing benefit. Free-response feedback also indicated that COVID-19 negatively impacted students' mental well-being and inhibited opportunities to complete away sub-internships. As for supplemental resources, students appreciated virtual grand rounds/teaching, interest group events, online resources, and meetings with attendings/residents.

CONCLUSIONS

According to students, COVID-19 negatively impacted a broad array of otolaryngology educational experiences including research, faculty interaction, and interest group involvement. Students also indicated several well-received adaptations, such as virtual mentorship programs, curated video materials, remote research opportunities, and online question banks. This feedback helps contextualize selection committee decisions and, importantly, assists clerkship directors and undergraduate medical educators to optimize their curriculums.

Comparing Feedback Techniques in Bilobe Flap Simulation Using 3D-Printed Facial Models

Objective

To compare live versus delayed feedback on trainee performance of bilobe flaps using 3-dimensional (3D)-printed facial simulators and determine whether these effects are sustained on repeat performance.

Study Design

Cohort study.

Setting

University of Arkansas for Medical Sciences.

Methods

3D-printed facial models with a nasal ala defect were provided to 18 subjects. Subjects were stratified and randomized based on their training level into 1 of 3 groups corresponding to live feedback (Group 1), delayed feedback (Group 2), and no feedback (Group 3). Subjects performed a bilobe flap following a structured lecture. Four weeks later, subjects independently repeated the exercise on the contralateral ala. Likert surveys were used to assess subjective parameters. Objective grading was performed by a plastic surgeon, which included a point system and score for the overall appearance.

Results

Following exercise 1, Group 1 reported a significant improvement in knowledge (P < .001), which was sustained after exercise 2 (P < .001); Group 2 reported a significant improvement after exercise 1 (P = .03) but was not sustained (P = .435). After the second exercise, Group 1 and Group 2 improved their confidence in bilobed repair (P = .001 and P = .003, respectively), but this was greater for Group 1. Group 1 showed a significant improvement in their design time following exercise 2 (P = .007). There were no significant differences between groups on total time for repair, total score, and appearance.

Conclusion

3D-printed models are valuable in teaching the bilobe flap for nasal defects, with live feedback providing the greatest level of improvement in self-reported knowledge and confidence.

Simulation-based workshop for emergency preparedness in otolaryngology

Objectives

This study aimed to evaluate the outcomes of a hands-on simulation-based course with emphasis on procedural techniques, clinical reasoning, and communication skills developed to improve junior Otolaryngology - Head and Neck Surgery (OHNS) residents' preparedness in managing otolaryngologic emergencies.

Methods

Junior OHNS residents and faculty from residency programs in California, Nevada, and Arizona participated in this workshop in 2020 and 2021. The stations featured airway management techniques, ultrasound-guided needle aspiration, nasoseptal hematoma evacuation, and facial fracture repair using various models and cadavers. Participants completed a pre-workshop survey, post-workshop survey, and 2-month follow-up survey that assessed resident anxiety and confidence in three OHNS emergency situations across knowledge, manual skills, and teamwork using a 5-point Likert scale.

Results

Pre-workshop surveys reported the least anxiety and most confidence in teamwork, but the most anxiety and least confidence in technical skills and knowledge related to foreign body retrieval and airway management. Immediately post-workshop participants reported significant reductions in anxiety and increases in confidence, largest in the manual skills domain, in foreign body retrieval (anxiety: -0.99, confidence: +0.95, p < .01) and airway management stations (anxiety: -0.68, confidence: +1.07, p < .01). Data collected for the epistaxis station showed decreasing confidence and increasing anxiety following the workshop.

Conclusion

Our findings demonstrate the effectiveness of a workshop in preparing junior residents in potentially lifesaving otolaryngologic techniques that residents will encounter. Optimizing use of simulation centered training can inform the future of residency education, improving confidence and decreasing anxiety in residents responsible for the safety of patients.

Level of Evidence

III.

Training of Family Medicine residents in the first year of the COVID-19 pandemic

Background

The immediate impact of the pandemic on resident training has been well documented. As the pandemic and its effects persisted beyond what was initially predicted, this study aimed to assess the impact of the pandemic on the training of family medicine (FM) residents a year after it began and to assess the burnout residents experienced during this period.

Methods

The survey was conducted between January 18 and February 18, 2021. Participation was solicited via an email sent to the program directors throughout the US, who were asked to circulate the survey among their residents. The questionnaire was divided into sections to assess the impact of the pandemic on clinical training, didactics, and preparedness for the next phase in the career. In addition, the burnout experienced was assessed using the Copenhagen Burnout Inventory.

Results

227 responses were analyzed. 83% (n = 186) of respondents felt that the pandemic had a negative impact on their training and 63% (n = 141) felt that the pandemic had a negative impact on didactics. 50% (n = 44) of the third-year residents thought that they would be able to meet the graduation requirement for outpatient encounters. 41% (n = 36) of the third-year residents felt less prepared for the next step in their careers. 119 respondents met the cutoff threshold for personal burnout, 134 for work-related burnout, and 65 for client-related burnout.

Conclusion

Residency training is difficult with high reported rates of burnout before the COVID-19 pandemic. This study reinforces the evidence that the pandemic made both mental well-being and adequate training more difficult for FM residents across the country.

COVID-19 Did Not Stop the Rising Tide: Trends in Case Volume Logged by Surgical Residents

INTRODUCTION

The coronavirus pandemic has profoundly impacted all facets of surgical care, including surgical residency training. The objective of this study was to assess the operative experience and overall case volume of surgery residents before and during the pandemic.

METHODS

Using data from the Accreditation Council for Graduate Medical Education annual operative log reports, operative volume for 2015 to 2021 graduates of Accreditation Council for Graduate Medical Education -accredited general, orthopedic, neuro- and plastic surgery residency programs was analyzed using nonparametric Kendall-tau correlation analysis. The period before the pandemic was defined as AY14-15 to AY18-19, and the pandemic period was defined as AY19-20 to AY20-21.

RESULTS

Operative data for 8556 general, 5113 orthopedic, 736 plastic, and 1278 neurosurgery residency graduates were included. Between 2015 and 2021, total case volume increased significantly for general surgery graduates (Kendall's tau-b: 0.905, p = 0.007), orthopedic surgery graduates (Kendall's tau-b: 1.000, p = 0.003), neurosurgery graduates (Kendall's tau-b: 0.905, p = 0.007), and plastic surgery graduates (Kendall's tau-b: 0.810, p = 0.016). Across all specialties, the mean total number of cases performed by residents graduating during the pandemic was higher than among residents graduating before the pandemic, though no formal significance testing was performed. Among general surgery residents, the number of cases performed as surgeon chief among residents graduating in AY19-20 decreased for the first time in 5 years, though the overall volume remained higher than the prior year, and returned to prepandemic trends in AY20-21.

CONCLUSIONS

Over the past 7 years, the case volume of surgical residents steadily increased. Surgical trainees who graduated during the coronavirus pandemic have equal or greater total operative experience compared to trainees who graduated prior to the pandemic.

Pediatric otolaryngology trends in patient care volume during covid-19: A survey study

PURPOSE

To assess changes in outpatient clinic, inpatient consult, and operative volumes among pediatric otolaryngologists in response to the COVID-19 pandemic.

MATERIALS AND METHODS

An online questionnaire was distributed to 535 active members of the American Society of Pediatric Otolaryngology from April 21, 2020, to May 4, 2020. The questionnaire assessed operative and clinical volumes during a two-week period between April 6, 2020, to April 20, 2020, while restrictions on elective surgery were in place, as compared to an average two-week period before the start of the COVID-19 pandemic.

RESULTS

Both outpatient clinic and inpatient consult visit volume decreased significantly during the Covid-19 period. Academic practitioners typically reported seeing fewer outpatient visits than their private practice counterparts. Operative case volume decreased significantly across all procedures and surgeries common to pediatric otolaryngology. One-third of surveyed surgeons reported no operative cases during the assessed period.

CONCLUSIONS

Pediatric otolaryngologists reported a severe reduction in operative volume, in-office visits, and inpatient consults during a time period at the peak of the 2020 Covid-19 outbreak. Many respondents saw no patients, nor operated in any capacity. This time period could have lasting effects on practitioner finances and trainee education.

Health worker education during the COVID-19 pandemic: global disruption, responses and lessons for the future-a systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis identified early evidence quantifying the disruption to the education of health workers by the COVID-19 pandemic, ensuing policy responses and their outcomes.

METHODS

Following a pre-registered protocol and PRISMA/AMSTAR-2 guidelines, we systematically screened MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and Google Scholar from January 2020 to July 2022. We pooled proportion estimates via random-effects meta-analyses and explored subgroup differences by gender, occupational group, training stage, WHO regions/continents, and study end-year. We assessed risk of bias (Newcastle-Ottawa scale for observational studies, RοB2 for randomized controlled trials [RCT]) and rated evidence certainty using GRADE.

RESULTS

Of the 171 489 publications screened, 2 249 were eligible, incorporating 2 212 observational studies and 37 RCTs, representing feedback from 1 109 818 learners and 22 204 faculty. The sample mostly consisted of undergraduates, medical doctors, and studies from institutions in Asia. Perceived training disruption was estimated at 71.1% (95% confidence interval 67.9-74.2) and learner redeployment at 29.2% (25.3-33.2). About one in three learners screened positive for anxiety (32.3%, 28.5-36.2), depression (32.0%, 27.9-36.2), burnout (38.8%, 33.4-44.3) or insomnia (30.9%, 20.8-41.9). Policy responses included shifting to online learning, innovations in assessment, COVID-19-specific courses, volunteerism, and measures for learner safety. For outcomes of policy responses, most of the literature related to perceptions and preferences. More than two-thirds of learners (75.9%, 74.2-77.7) were satisfied with online learning (postgraduates more than undergraduates), while faculty satisfaction rate was slightly lower (71.8%, 66.7-76.7). Learners preferred an in-person component: blended learning 56.0% (51.2-60.7), face-to-face 48.8% (45.4-52.1), and online-only 32.0% (29.3-34.8). They supported continuation of the virtual format as part of a blended system (68.1%, 64.6-71.5). Subgroup differences provided valuable insights despite not resolving the considerable heterogeneity. All outcomes were assessed as very-low-certainty evidence.

CONCLUSION

The COVID-19 pandemic has severely disrupted health worker education, inflicting a substantial mental health burden on learners. Its impacts on career choices, volunteerism, pedagogical approaches and mental health of learners have implications for educational design, measures to protect and support learners, faculty and health workers, and workforce planning. Online learning may achieve learner satisfaction as part of a short-term solution or integrated into a blended model in the post-pandemic future.

The Impact of COVID-19 on Surgical Training and Education

The COVID-19 pandemic disrupted conventional medical education for surgical trainees with respect to clinical training, didactics, and research. While the effects of the COVID-19 pandemic on surgical trainees were variable, some common themes are identifiable. As hordes of COVID-19 patients entered hospitals, many surgical trainees stepped away from their curricula and were redeployed to other hospital units to care for COVID-19 patients. Moreover, the need for social distancing limited traditional educational activities. Regarding clinical training, some trainees demonstrated reduced case logs and decreased surgical confidence. For residents, fellows, and medical students alike, most didactic education transitioned to virtual platforms, leading to an increase in remote educational resources and an increased emphasis on surgical simulation. Resident research productivity initially declined, although the onset of virtual conferences provided new opportunities for trainees to present their work. Finally, the pandemic was associated with increased anxiety, depression, and substance use for some trainees. Ultimately, we are still growing our understanding of how the COVID-19 pandemic has redefined surgical training and how to best implement the lessons we have learned.

Impact of the COVID-19 Pandemic on Brazilian Head and Neck Surgery Centers

OBJECTIVE

The outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers.

METHODS

An anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April‒June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020.

RESULTS

The response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n=19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly.

CONCLUSIONS

The COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment.

LEVEL OF EVIDENCE

Evidence from a single descriptive study.

Deterioration experienced by French otolaryngology residents in their training during the COVID-19 pandemic: A STROBE analysis

OBJECTIVE

To evaluate the impact of the first three waves of COVID-19 on the academic and surgical training of ENT and Head and Neck Surgery residents in France.

MATERIAL AND METHODS

Observational, retrospective study. A 55-item survey of academic education and surgical training was sent to ENT residents in five major French regions (Île-de-France, Rhône-Alpes Auvergne, Occitanie, Grand Est, Grand Ouest) from August to October 2021.

RESULTS

Eighty-nine out of 135 residents (66%) responded. Two-thirds considered that surgical training was more affected than academic education, with reductions evaluated of 50-75%, 25-50% and 0-25% for the first three waves, respectively. Residents in Île-de-France, Rhône-Alpes Auvergne and Grand Est were the most affected by the first wave (75-100% reduction in surgical activity, in parallel to increased admissions). Otology, rhinology and functional exploration were the most affected, whereas pediatrics and oncology were spared. Seventy-one of the 89 residents (79.7%) felt that the first wave impacted their career, while this proportion decreased to 39.3% and 44.9% for the second and third waves, respectively.

CONCLUSION

The first wave of COVID-19, compared to the following two waves, severely impacted the surgical training of French ENT residents, especially in regions severely impacted by the pandemic, while academic education was relatively safeguarded by the implementation of e-learning alternatives.

Perception of pediatric residents from a tertiary hospital in the city of México regarding their training during the COVID-19 pandemic

BACKGROUNDS

On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic, which changed the residents' teaching and learning process. The purpose of this study was to determine residents' satisfaction and impressions on their training during the pandemic in a tertiary pediatric hospital.

METHODS

This was a descriptive cross-sectional study. An online survey was designed to determine residents' demographic and personal characteristics, as well as their perception about the theoretical and practical training, as well as about their emotional situation. The analysis separated medical students from surgical students in order to identify any differences existing between these groups, for which χ2 was calculated.

RESULTS

Overall, 148 of 171 residents (86.5%) responded to the questionnaire; 75% belonged to the medical specialty and 25% to the surgical specialty. Statistically significant differences were found in terms of those training aspects they were concerned about during the pandemic (p < 0.001) and about the difficulties associated with online learning (p = 0.001). Differences were also found regarding their satisfaction toward the time needed to complete their thesis (p = 0.059) and activities outside the hospital (p = 0.029). Regarding their degree of satisfaction in general, most medical specialty students felt slightly satisfied (43.2%) and surgical specialty students felt mostly neutral (37.8%). Regarding their feelings about their mental health, statistically significant differences were found between both groups (p = 0.038) although both groups reported the same percentage of overall dissatisfaction (2.7%) in this area.

CONCLUSION

The COVID-19 pandemic has brought significant challenges to medical education systems. Lack of practice in decision-making and maneuver execution are concerns for residents and may affect their future professional performance.

The Lasting Impact of the COVID-19 Pandemic on Surgical Key Indicator Cases for Otolaryngology Residency Education

OBJECTIVES

Early on during the COVID-19 pandemic, the US Centers for Medicare & Medicaid Services (CMS) and other government as well as medical institutions recommended that surgeons postpone nonessential surgeries. The aim of our study is to examine the impact of the COVID-19 pandemic on otolaryngology surgical training by evaluating changes in surgical volumes through various time points relative to the height of the pandemic.

METHODS

We performed a retrospective review of all surgical cases performed by the Otolaryngology-Head and Neck Surgery department at a tertiary care academic center from 3 time periods: July 1st, 2018, to June 30th, 2019; July 1st, 2019, to June 30th, 2020; and July 1st, 2020, to June 30th, 2021.

RESULTS

From the 2018-19 period to the 2020-21 period, the total number of overall cases decreased by 9.9%, from 2386 to 2148 cases. During this same time duration, the number of key indicator cases decreased by 13.4%, from 1715 to 1486 cases. Relative to other cases, ethmoidectomy, rhinoplasty, and stapes/OCR cases decreased the most during the 2019-20 period by 41.9%, 41.8%, and 29.5%, respectively. From the 2018-19 period to the 2020-21 period, thyroid/parathyroid cases decreased the most by 35.4%. Only ethmoidectomy and oral cavity cases showed increases during this period at 9.7% and 24.4%, respectively.

CONCLUSIONS

Although case volumes have stayed relatively constant, key indicator case volumes at the present tertiary care academic center have not yet fully recovered from the COVID-19 pandemic. Efforts must be made to determine how this has impacted residency surgical education.

Otolaryngology in the face of A pandemic

Although infrequent, pandemics are serious public health concerns with unpredictable courses. The COVID-19 pandemic began over 2 years ago and is far from over. This pandemic has spread rapidly throughout the world and led to several million deaths, making it commonly compared to the deadly Spanish influenza pandemic. Policy and safety measures are constantly being adapted to reduce transmission rates. The pandemic places stress on all healthcare workers, but especially otolaryngology providers due to their direct contact with airway connected cavities. This puts them at high risk for infection and has impacted inpatient and outpatient otolaryngology care, as well as education, research, and mental health.

COVID-19 impact on junior doctor education and training: a scoping review

COVID-19 has had a significant impact on healthcare resources and the medical workforce. Clinically-based medical education is the principal source of learning, and this has been profoundly impacted by restrictions due to COVID-19. It follows that junior medical staff and their education would be significantly impacted due to the altered volume and breadth of their clinical exposure. Some literature has been published regarding the impact to medical training during COVID-19. This study sought to review junior medical staff perceptions and their reported impact of the COVID-19 pandemic on their education and training.Nine databases (three Ovid MEDLINE databases, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Centre and PsychINFO) were searched for studies published in 1 January 2020 through 24 August 2020. Via a scoping review protocol, an iterative process was used to perform the identification, review and charting analysis of the reported outcomes and themes. Descriptive analysis was performed using quantitative and qualitative methods.Of the 25 343 sources identified, 32 were included in the review. There were studies published from nearly all continents, predominantly in surgical journals, with a wide spread of specialties. Themes identified included the current impact of the pandemic in relation to continuation of and modifications to training programmes, as well as the future impact due to training requirements and career progression.Junior medical staff report that the COVID-19 pandemic has had a significant impact on their education and training. Whether the changes imposed by the pandemic on education are temporary measures or permanent fixtures, and whether standards of competence may be impacted, is not yet known. This scoping review forms a basis for further investigation in the field.

Using Technology Adoption Theories to Maximize the Uptake of E-learning in Medical Education

INTRODUCTION

While the use of e-learning tools in medical education is guided by robust literature on their design and evaluation, there is sparse literature on strategies that maximize their adoption among trainees.

METHODS

In this scoping review, we searched Web of Science for studies on technology adoption theories as applied to education, using a final censoring date of August 1, 2021.

RESULTS

Based on our findings, we identified three representative theories: (1) technology acceptance model, (2) technology adoption life cycle, and (3) domestication theory.

DISCUSSION

We describe these theories in detail, examine their prior applications, and propose specific uses within medical e-learning.

Professionalism: COVID-19 made me do it!

PURPOSE OF REVIEW

COVID-19 pandemic has created profound ethical challenges, not only for clinical decision-making but also for defining physician professional conduct.

RECENT FINDINGS

Multiple ethical questions arose as the COVID-19 pandemic ravaged globally, including physician obligations in a pandemic, allotment of personal protective equipment, care of unvaccinated patients, discern between evidence-based and unreliable information, addressing end-of-life wishes, implications of involving medical students in a public health crisis, and finally physician burnout aggravated by a pandemic.

SUMMARY

There is a need to redefine existing medical professionalism standards so that future healthcare professionals are well prepared to deal with similar public health crisis.

Effects of Persistent Exposure to COVID-19 on Mental Health Outcomes Among Trainees: a Longitudinal Survey Study

BACKGROUND

The rapid spread of the coronavirus disease 2019 (COVID-19) has created considerable strain on the physical and mental health of healthcare workers around the world. The effects have been acute for physician trainees-a unique group functioning simultaneously as learners and care providers with limited autonomy.

OBJECTIVE

To investigate the longitudinal effects of physician trainee exposure to patients being tested for COVID-19 on stress, anxiety, depression, and burnout using three surveys conducted during the early phase of the pandemic.

DESIGN

Longitudinal survey study.

PARTICIPANTS

All physician trainees (N = 1375) at an academic medical center.

MAIN MEASURE

Assess the relationship between repeated exposure to patients being tested for COVID-19 and stress, anxiety, depression, and burnout.

KEY RESULTS

Three hundred eighty-nine trainees completed the baseline survey (28.3%). Of these, 191 and 136 completed the ensuing surveys. Mean stress, anxiety, and burnout decreased by 21% (95% confidence interval (CI): - 28 to - 12%; P < 0.001), 25% (95% CI: - 36 to - 11%; P < 0.001), and 13% (95% CI: - 18 to - 7%; P < 0.001), respectively, per survey. However, for each survey time point, there was mean increase in stress, anxiety, and burnout per additional exposure: stress [24% (95% CI: + 12 to + 38%; P < 0.001)], anxiety [22% (95% CI: + 2 to + 46%; P = 0.026)], and burnout [18% (95% CI: + 10 to + 28%; P < 0.001)]. For depression, the association between exposure was strongest for the third survey, where mean depression scores increased by 33% per additional exposure (95% CI: + 18 to + 50%; P < 0.001).

CONCLUSIONS

Training programs should adapt to address the detrimental effects of the "pileup" of distress associated with persistent exposure through adaptive programs that allow flexibility for time off and recovery.

Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19

OBJECTIVE

The COVID-19 pandemic has spurred widespread adoption and advancement in telehealth activities, representing a marked change in otolaryngology practice patterns. The present study undertakes a scoping review of research focused on telehealth in otolaryngology (teleotolaryngology) to identify key themes and commonly utilized outcome measures that will assist future development in this growing field.

DATA SOURCES

PubMed, Embase, and Cochrane databases and reference review.

REVIEW METHODS

Per guidelines of the PRISMA Extension for Scoping Reviews, we performed database queries using a comprehensive search strategy developed in collaboration with research librarians at the Columbia University Irving Medical Center. We identified 596 unique references to undergo title and abstract review by 2 independent reviewers, leaving 439 studies for full-text review.

RESULTS

We included 285 studies for extraction of notable findings, leaving 262 unique studies after accounting for content overlap. We identified core outcome measures, including patient and provider satisfaction, costs and benefits, quality of care, feasibility, and access to care. Publication volume increased markedly over time, though only 4% of studies incorporated randomized study group assignment. Using an iterative approach to thematic development, we organized article content across 5 main themes: (1) exploration of teleotolaryngology evolution, (2) role in virtual clinical encounters, (3) applications in interdisciplinary care and educational initiatives, (4) emerging and innovative technologies, and (5) barriers to implementation.

CONCLUSION

This scoping review of teleotolaryngology documents its evolution and identifies current use cases, limitations, and emerging applications, providing a foundation from which to build future studies, inform policy decision making, and facilitate implementation where appropriate.

An analysis of anatomy education before and during Covid-19: August-December 2020

Coronavirus disease-2019 (Covid-19) disrupted the in-person teaching format of anatomy. To study changes in gross anatomy education that occurred during August-December, 2020 compared to before the pandemic, an online survey was distributed to anatomy educators. The 191 responses received were analyzed in total and by academic program, geographic region, and institution type. Cadaver use decreased overall (before: 74.1 ± 34.1%, during: 50.3 ± 43.0%, P < 0.0001), as well as across allopathic and osteopathic medicine, therapy, undergraduate, and veterinary programs (P < 0.05), but remained unchanged for other programs (P > 0.05). Cadaver use decreased internationally and in the US (P < 0.0001), at public and private (P < 0.0001) institutions, and among allopathic medical programs in Northeastern, Central, and Southern (P < 0.05), but not Western, US geographical regions. Laboratories during Covid-19 were delivered through synchronous (59%), asynchronous (4%), or mixed (37%) formats (P < 0.0001) and utilized digital resources (47%), dissection (32%), and/or prosection (21%) (P < 0.0001). The practical laboratory examination persisted during Covid-19 (P = 0.419); however, the setting and materials shifted to computer-based (P < 0.0001) and image-based (P < 0.0001), respectively. In-person lecture decreased during Covid-19 (before: 88%, during: 24%, P = 0.003). When anatomy digital resources were categorized, dissection media, interactive software, and open-access content increased (P ≤ 0.008), with specific increases in BlueLink, Acland's Videos, and Complete Anatomy (P < 0.05). This study provided evidence of how gross anatomy educators continued to adapt their courses past the early stages of the pandemic.

What is the impact of the COVID-19 pandemic on residency training: a systematic review and analysis

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical education in addition to clinical systems. Residency training has probably been the most affected aspect of medical education during the pandemic, and research on this topic is crucial for educators and clinical teachers. The aim of this study was to understand the effect of the COVID-19 pandemic comprehensively through a systematic review and analysis of related published articles.

METHODS

A systematic review was conducted based on a predesigned protocol. We searched MEDLINE and EMBASE databases until November 30, 2020, for eligible articles. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed.

RESULTS

In total, 53 original articles that investigated the effect of the COVID-19 pandemic on residency training were included. Studies from various regions were included in the research, with the largest percentage from the United States (n = 25, 47.2%). Most of these original articles were questionnaire-based studies (n = 44, 83%), and the research target groups included residents (79.55%), program directors (13.64%), or both (6.82%). The majority of the articles (n = 37, 84.0%) were published in countries severely affected by the pandemic. Surgery (n = 36, 67.92%) was the most commonly studied field.

CONCLUSIONS

The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns. Further studies should be conducted with a focus on the learning outcomes of residency training during the pandemic and the effectiveness of assisted teaching methods.

Online residency training during the COVID-19 pandemic: a national survey of otolaryngology head and neck surgery program directors

BACKGROUND

The COVID-19 pandemic has deeply impacted healthcare and education systems, including resident education. The impact of the pandemic on the different types of pedagogical activities, and the displacement of pedagogical activities to online modalities have not yet been quantified. We sought to evaluate the impact of the COVID-19 pandemic on formal pedagogic components of otorhinolaryngology-head and neck surgery (ORL-HNS) residency, the switch to distance learning and program director's perceptions of the future of teaching and learning.

METHODS

A nationwide online survey was conducted on Canadian ORL-HNS program directors. The use of standard didactic activities in-person and online, before and during the pandemic was rated with Likert scales. Perceptions of the pandemic were described with open-ended questions.

RESULTS

A total of 11 of the 13 program directors contacted responded. The analysis were conducted using nonparametric statistics. There was a significant drop in overall didactic activities during the pandemic, regardless of the teaching format (3.5 ± 0.2 to 3.1 ± 0.3, p < 0.05). The most affected activities were simulation and in-house lectures. Online activities increased dramatically (0.5 ± 0.2 to 5.0 ± 0.5, p < 0.001), including attendance to lectures made by other programs (0.5 ± 0.3 to 4.0 ± 0.8, p < 0.05). Respondents stated their intention to maintain the hybrid online and in-person teaching model.

CONCLUSIONS

These findings suggest that hybrid online and in-person teaching is likely to persist in the post-pandemic setting. A balanced residency curriculum requires diversity in academic activities. The pandemic can have positive consequences if higher education institutions work to better support distance teaching and learning.

COVID-19 Pandemic and its Impact on the Management of Head and Neck Cancer in the Spanish Healthcare System

Introduction  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has represented a major challenge for healthcare systems worldwide, changing the habits of physicians. A reorganization of healthcare activity has been necessary, limiting surgical activity to essential cases (emergencies and oncology), and improving the distribution of health resources.

Objective  To analyze the impact of the COVID-19 pandemic on head and neck cancer surgery management in Spain.

Methods  A cross-sectional study, through an anonymous and voluntary online survey distributed to 76 Spanish otorhinolaryngology departments.

Results  A total of 44 centers completed the survey, 65.9% of which were high-volume. A total of 45.5% of them had to stop high-priority surgery and 54.5% of head and neck surgeons were relocated outside their scope of practice. Surgeons reported not feeling safe during their usual practice, with a decrease to a 25% of airway procedures. A total of 29.5% were “forced” to deviate from the “standard of care” due to the epidemiological situation.

Conclusions  Approximately half of the departments decreased their activity, not treating their patients on a regular basis, and surgeons were reassigned to other tasks. It seems necessary that the head and neck surgeons balance infection risk with patient care. The consequences of the reported delays and changes in daily practice should be evaluated in the future in order to understand the real impact of the pandemic on the survival of head and neck cancer patients.

Lived Experiences of Surgical Residents During the COVID-19 Pandemic: A Qualitative Assessment

OBJECTIVE

As the COVID-19 pandemic dynamically changes our society, it is important to consider how the pandemic has affected the training and wellness of surgical residents. Using a qualitative study of national focus groups with general surgery residents, we aim to identify common themes surrounding their personal, clinical, and educational experiences that could be used to inform practice and policy for future pandemics and disasters.

DESIGN

Six 90-minute focus groups were conducted by a trained qualitative researcher who elicited responses on six predetermined topics. De-identified transcripts and audio recordings were later analyzed by two independent researchers who organized responses to each topic into themes.

SETTING

Focus groups were conducted virtually and anonymously.

PARTICIPANTS

General surgery residents were recruited from across the country. Demographic information of potential participants was coded, and subjects were randomly selected to ensure a diverse group of participants.

RESULTS

The impact of the COVID-19 pandemic on residents' clinical, educational, and personal experiences varied depending on the institutional response of the program and the burden of COVID-19 cases geographically. Many successes were identified: the use of telehealth and virtual didactics, an increased sense of camaraderie amongst residents, and flexibility in scheduling. Many challenges were also identified: uncertainty at work regarding personal protective equipment and scheduling, decreased case volume and educational opportunities, and emotional trauma and burnout associated with the pandemic.

CONCLUSIONS

These data gathered from our qualitative study highlight a clear, urgent need for thoughtful institutional planning and policies for the remainder of this and future pandemics. Residency programs must ensure a balanced training program for surgical residents as they attempt to master the skills of their craft while also serving as employed health care providers in a pandemic. Furthermore, a focus on wellness, in addition to clinical competency and education, is vital to resident resilience and success in a pandemic setting.

The Effect of the Coronavirus-2019 Pandemic on Pediatric Critical Care Fellowship Training

Objective: To assess the impact of the coronavirus-2019 (COVID-19) pandemic on pediatric critical care medicine (PCCM) fellowship training through a cross-sectional survey of both program directors (PDs) and fellows. Design: Cross-sectional internet-based survey. Setting: Accreditation Council for Graduate Medical Education (ACGME)-accredited PCCM fellowship programs in the United States. Subjects: PCCM PDs and fellows. Results: A total of 34 PDs and 92 fellows responded to the national survey (rate of 47% and 17%, respectively). The majority (69%) of respondents agreed that medical education has been negatively impacted by the COVID-19 pandemic. When PDs were surveyed, 91% noted a significant decrease in the patient census since March 2020, with 59% citing a >15% decrease. Further, 65% reported trainees had less procedural experience. All respondents reported that education was at least in part provided through virtual learning platforms, with nearly half having exclusive remote learning without in-person sessions. Fifty percent of PDs and 62% of fellows reported decreased learner engagement during virtual didactics when compared to in-person education. The majority of PDs reported specific decreases in simulation, procedural skills training, and ultrasound training. Few PDs (15%) and fellows (13-16%) reported redeployment to adult patient care, with northeastern programs having the highest rates. In univariate analyses, decreased PDs confidence in trainee procedural skills was associated with reported decreases in number of procedures performed (P = .0006) and number of procedural skills didactic sessions (P = .0245). Change in the unit census was associated with less PDs confidence in fellows' medical knowledge (P = .0004), fellows' management skills (P = .0232), and fellows' procedural skills (P = .0003), with larger decreases in patient census correlating with larger decreases in confidence. Conclusions: The COVID-19 pandemic has significantly impacted the education and clinical training of PCCM fellows. More knowledge on this topic can assist PDs in curriculum changes for the future to address any gaps in learning that have occurred.

The impact of COVID-19 pandemic on students' learning in higher education in Afghanistan

COVID-19 pandemic has been a global serious issue that adversely impacted humans' life. This study aimed to investigate the impact of the COVID-19 pandemic on students' learning in higher education in Afghanistan. A mixed method research design was employed in conducting the study. The quantitative data were gathered using an online survey questionnaire from 592 randomly selected students and 6 semi-structured interviews were conducted to collect qualitative data. Statistical Package for Social Sciences (SPSS) was used to analyse the quantitative data and the qualitative data were coded and analysed thematically. The quantitative finding showed that the students did not experience a constant online teaching and learning during the COVID-19 pandemic. It also revealed that the COVID-19 pandemic devastatingly affected students' learning in higher education in Afghanistan. In addition, the qualitative finding revealed that the students had problems with Internet and technological facilities in their learning and they suggested that the Ministry of Higher Education should design and introduce a practical online platform which will be free and accessible with a poor Internet connection because some of the students live in areas where the Internet speed is very slow. The finding of the study will help educational managers and higher education leaders to review and adopt policies for teaching and learning in emergency cases. It will also help lecturers to design a proper plan and improve their instruction.

Impact of the first COVID-19 wave on surgical training in Flanders: are we losing competence?

BACKGROUND

The COVID-19 pandemic has tremendously impacted the healthcare system and residency programs worldwide. Surgical residents were redeployed to COVID-19 units, whereas education and scientific didactics were reduced. The aim of this study is to identify the impact of COVID-19 on Flemish surgical residents' education, personal life and volume of performed surgeries.

METHODS

A cross-sectional retrospective survey on educational and personal impact during the first COVID-19 wave was administered anonymously to all surgical residents in Flanders. A quantitative comparison of performed surgeries during this period and the same period a year earlier was conducted.

RESULTS

A total of 193 surgical residents (46%) completed the survey. 63% of residents were no longer admitted to multidisciplinary oncologic meetings and 107 (55%) residents had no longer any scientific theoretical meetings at all. Almost one in two residents (46%) indicated more than 50% reduction in time in the operating theater and one in three (31%) residents were involved in care for COVID-19 positive surgical patients. Seventy-eight percent of the residents experienced a negative impact on their surgical training and 41% experienced a negative influence on their private situation. Performed surgical cases during the COVID-19 period were on average 40% less for second, third- and fourth-year residents.

CONCLUSION

Surgical residents perceived a high negative impact on personal and professional lives during the start of the COVID-19 pandemic in Flanders. Education and training programs were cancelled and volume of performed surgeries decreased tremendously. Policymakers and surgical program coordinators should ensure surgical education during further evolution of this and future pandemics.

The impact of the COVID-19 pandemic on family medicine residency training

BACKGROUND

Family physicians have played a unique clinical role during the COVID-19 pandemic. We hypothesized that the pandemic would be associated with significant deleterious effects on clinical activity, educational training, personal safety and well-being.

OBJECTIVE

We conducted a national survey to obtain preliminary data that would assist in future targeted data collection and subsequent evaluation of the impact of the pandemic on family medicine residents and teaching faculty.

METHODS

An anonymous online survey of residents and faculty was distributed via the Association of Family Medicine Residency Directors list serve between 5/21/2020 and 6/18/2020. Survey questions focused on clinical and educational activities, safety and well-being.

RESULTS

One hundred and fifty-three residents and 151 teaching faculty participated in the survey. Decreased clinical activity was noted by 81.5% of residents and 80.9% of faculty and the majority began conducting telehealth visits (97.9% of residents, 91.0% of faculty). Distance learning platforms were used by all residents (100%) and 39.6% noted an overall positive impact on their education. Higher levels of burnout did not significantly correlate with reassignment of clinical duties (residents P = 0.164; faculty P = 0.064). Residents who showed significantly higher burnout scores (P = 0.035) and a decline in levels of well-being (P = 0.031) were more likely to participate in institutional well-being support activities.

CONCLUSIONS

Our preliminary data indicate that family medicine residents and teaching faculty were profoundly affected by the COVID-19 pandemic. Future studies can be directed by current findings with focus on mitigation factors in addressing globally disruptive events such as COVID-19.

Adult Hip and Knee Reconstruction Education during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic caused an abrupt disruption in residency and fellowship training, with most in-person teaching ceasing in March 2020. The AAHKS (American Association of Hip and Knee Surgeons) Board of Directors quickly initiated an online lecture series named the Fellows Online COVID-19 AAHKS Learning initiative. The purpose of this study is to illustrate the impact that this educational platform had on residents and adult hip and knee reconstruction fellows.

METHODS

Between March 31, 2020 and June 25, 2020 an online educational platform was simultaneously developed and delivered. Adult hip and knee reconstruction fellows and residents were invited to participate in the free, live, online education sessions. Faculty from well-respected institutions from around the United States volunteered their time to host the initiative, choosing topics to present, ranging from hip (13 lectures) and knee (9 lectures), to practice management/miscellaneous (12 lectures). Attendee registrations were tracked via the online platform and the maximum number of attendees per session was recorded. A survey was administered to attendees for feedback.

RESULTS

Thirty-four, 1-hour virtual lectures were delivered in real time by 79 different faculty members from 20 different institutions. A total of 4746 registrations for the 34 lectures were received, with 2768 registrants (58.3%) attending. The average attendance was 81 viewers per session (range 21-143), with attendance peaking mid-April 2020. A survey administered to lecture participants showed that 104/109 (95.4%) attended live lectures and 93/109 (85.3%) watched recorded sessions. About 92.5% of attendees responded that they wanted the lectures to continue after clinical responsibilities resumed.

CONCLUSION

Amid a pandemic with cessation of in-person training, AAHKS delivered a robust virtual training alternative, exposing residents and fellows to a variety of renowned faculty and topics. Attendance with the program was very high, along with continued interest to continue this initiative. These worldwide lectures may lead to future opportunities in virtual residency and fellowship education.

The Impact of the COVID-19 Pandemic on Head and Neck Surgery Training: A Brazilian National Survey

Introduction  The COVID-19 pandemic has had a high impact on surgical training around the world due to required measures regarding the suspension of elective procedures and the dismissal of nonessential personnel.

Objectives  To understand the impact the pandemic had on head and neck surgery training in Brazil.

Methods  We conducted a 29-question online survey with head and neck surgery residents in Brazil, assessing the impact the pandemic had on their training.

Results  Forty-six residents responded to the survey, and 91.3% of them reported that their residency was affected by the pandemic, but most residents were not assigned to work directly with patients infected with the new coronavirus (71.4%). All residents reported decrease in clinic visits and in surgical procedures, mostly an important reduction of ∼ 75%. A total of 56.5% of the residents described that the pandemic has had a negative impact on their mental, health and only 4 (8.7%) do not have any symptoms of burnout. The majority (78.3%) of the residents reported that educational activities were successfully adapted to online platforms, and 37% were personally infected with the virus.

Conclusion  Most surgical residencies were greatly affected by the pandemic, and residents had an important decrease in surgical training. Educational activities were successfully adapted to online modalities, but the residency programs should search for ways of trying to compensate for the loss of practical activities.

Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns.

METHODS

All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables.

RESULTS

22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33-6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47-1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16-5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038).

CONCLUSIONS

Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

The impact of coronavirus 2019 on general surgery residency: A national survey of program directors

Background

Coronavirus disease 2019 (COVID-19) has had a widespread impact on graduate medical education. This survey aims to assess how general surgery residency programs adapted to the initial wave of the COVID-19 pandemic in the United States (US).

Materials and methods

General surgery program directors (PDs) in the US were invited to partake in a 16-question survey between April 17 and May 1, 2020. The survey included questions about basic program information, clinical practice changes, changes to education structure, surgery resident clinical duties, and perceived impact on resident operative experience and future career choices.

Results

Forty-eight PDs completed the survey in the designated two-week period. Almost all (44/48, 91.7%) programs changed their didactic education to an online video conference-based format. Thirteen programs (27.1%) decreased the amount/frequency of formal education, and 13 (27.1%) reported canceling didactic education for some period of time. The majority of PDs (26/48, 54.2%) felt these changes had no impact on resident didactic participation, 14 (29.2%) reported an increase in participation, and 8 (16.7%) reported decreased participation. Ten programs (20.8%) redeployed residents to non-surgical services at the time of this survey, 30 (62.5%) have not redeployed residents but plan to if needed, and 8 (16.7%) did not have any plans to redeploy residents.

Conclusions

The outbreak of COVID-19 has required general surgery residency PDs to change numerous aspects of resident education and clinical roles. Future inquiry is needed to assess if these changes lead to appreciable differences in resident preparedness and career selection.

•

At the time of this survey, all institutions had cancelled elect cases.

•

Over 90% of program directors implemented video-based didactic education.

•

Alternating blocks of on- and off-service was the most common schedule change.

•

Residents participated in “line” or “procedural” teams in 14.6% of programs.

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

BACKGROUND

To better understand how the COVID-19 pandemic has affected surgical trainees' and early-career surgeons' professional and personal experiences, a survey of the membership of the American College of Surgeons (ACS) Resident and Associate Society (RAS) and Young Fellows Association (YFA) was performed.

STUDY DESIGN

An anonymous online survey was disseminated to members of RAS and YFA. Descriptive analyses were performed and factors associated with depression and burnout were examined with univariate and multivariable stepwise logistic regression.

RESULTS

Of the RAS/YFA membership of 21,385, there were 1,160 respondents. The majority of respondents (96%) reported the COVID-19 pandemic having a negative impact on their clinical experience, with 84% of residents reporting a > 50% reduction in operative volume and inability to meet minimum case requirements. Respondents also reported negative impacts on personal wellness. Nearly one-third reported inadequate access to personal protective equipment, and depression and burnout were pervasive (≥21% of respondents reported yes to every screening symptom). On multivariable analysis, female sex (odds ratio [OR] 1.54 for depression, OR 1.47 for burnout) and lack of wellness resources (OR 1.55 for depression, OR 1.44 for burnout) predicted depression and burnout. Access to adequate personal protective equipment was protective against burnout (OR 0.52).

CONCLUSIONS

These data demonstrate a significant impact of the COVID-19 pandemic on the lives of residents and early-career surgeons. Actionable items from these data include mitigation of burnout and depression through increasing personal protective equipment access and provision of wellness programs, with a particular focus on high-risk groups.

The impact of COVID-19 on surgical training: a systematic review

Background

Coronavirus disease (COVID-19) has caused global disruption to health care. Non-urgent elective surgical cases have been cancelled, outpatient clinics have reduced and there has been a reduction in the number of patients presenting as an emergency. These factors will drastically affect the training opportunities of surgical trainees. The aim of this systematic review is to describe the impact of COVID-19 on surgical training globally.

Methods

The review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched.

Results

The searches identified 499 articles, 29 of which were included in the review. This contained data from more than 20 countries with 5260 trainees and 339 programme directors. Redeployment to non-surgical roles varied across studies from 6% to 35.1%. According to all of the studies, operative experience has been reduced. Knowledge learning had been switched to online platforms across 17 of the studies and 7 reported trainees had increased time to devote to educational/academic activities. All of the studies reporting on mental health report negative associations with increased stress, ranging from 54.9% to 91.6% of trainees.

Conclusions

The impact of COVID-19 on surgical trainees has been experienced globally and across all specialities. Negative effects are not limited to operative and clinical experience, but also the mental health and wellbeing of trainees. Delivery of surgical training will need to move away from traditional models of learning to ensure trainees are competent and well supported.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10151-020-02404-5.

Otolaryngology Resident Wellness, Training, and Education in the Early Phase of the COVID-19 Pandemic

OBJECTIVE

To determine changes in the residency experience early in the COVID-19 pandemic and evaluate wellness measures among otolaryngology residents.

METHODS

A web-based survey was administered to U.S. otolaryngology residents. Responses to the Shirom-Melamed Burnout Measure (SMBM) and the Generalized Anxiety Disorder-7 scale were recorded along with data on burnout, demographics, wellness, sleep, training, and education.

RESULTS

119 U.S. otolaryngology residents representing 27 of 42 states with otolaryngology residency programs responded to the survey. 24.4% (95% CI 17.0-31.8%) self-reported some level of burnout, while 10.9% met SMBM criteria for "clinically relevant" burnout. 51.3% experienced more stress, and 58.8% reported more anxiety during the COVID-19 pandemic. Compared to males, females had a higher prevalence of burnout (38.9% vs 12.3%, P = .001) and anxiety (75.9% vs 43.8%, P < .001). PGY-2s had a greater mean SMBM index (3.64) and higher rates of self-reported burnout (54.2%) than their counterparts at other levels of training. Residents reported less time spent in the hospital, lower surgical volume, and less procedural independence. Educational didactics, primarily via videoconference, were more frequent for 63.9% of respondents.

CONCLUSION

While burnout among otolaryngology residents was low early in the COVID-19 pandemic, likely due to separation from the workplace environment, trainees had higher levels of anxiety and stress. The surgical experience was negatively impacted by the pandemic, but remote didactics and educational opportunities increased. These findings may inform otolaryngology residency programs on the need to promote resident wellness and aid in devising strategies to improve the educational experience during this unique global health crisis as well as in the long term.

Impact of the COVID-19 Pandemic on Surgical Training and Learner Well-Being: Report of a Survey of General Surgery and Other Surgical Specialty Educators

BACKGROUND

The COVID-19 pandemic disrupted the delivery of surgical services. The purpose of this communication was to report the impact of the pandemic on surgical training and learner well-being and to document adaptations made by surgery departments.

STUDY DESIGN

A 37-item survey was distributed to educational leaders in general surgery and other surgical specialty training programs. It included both closed- and open-ended questions and the self-reported stages of GME during the COVID-19 pandemic, as defined by the ACGME. Statistical associations for items with stage were assessed using categorical analysis.

RESULTS

The response rate was 21% (472 of 2,196). US stage distribution (n = 447) was as follows: stage 1, 22%; stage 2, 48%; and stage 3, 30%. Impact on clinical education significantly increased by stage, with severe reductions in nonemergency operations (73% and 86% vs 98%) and emergency operations (8% and 16% vs 34%). Variable effects were reported on minimal expected case numbers across all stages. Reductions were reported in outpatient experience (83%), in-hospital experience (70%), and outside rotations (57%). Increases in ICU rotations were reported with advancing stage (7% and 13% vs 37%). Severity of impact on didactic education increased with stage (14% and 30% vs 46%). Virtual conferences were adopted by 97% across all stages. Severity of impact on learner well-being increased by stage-physical safety (6% and 9% vs 31%), physical health (0% and 7% vs 17%), and emotional health (11% and 24% vs 42%). Regardless of stage, most but not all made adaptations to support trainees' well-being.

CONCLUSIONS

The pandemic adversely impacted surgical training and the well-being of learners across all surgical specialties proportional to increasing ACGME stage. There is a need to develop education disaster plans to support technical competency and learner well-being. Careful assessment for program advancement will also be necessary. The experience during this pandemic shows that virtual learning and telemedicine will have a considerable impact on the future of surgical education.

Impact of the COVID-19 pandemic on Otolaryngology trainee education

BACKGROUND

The COVID-19 pandemic has reduced clinical volume with a negative impact on trainee education.

METHODS

Survey study of Otolaryngology trainees in North America, during the COVID-19 pandemic in April 2020.

RESULTS

Of 216 respondents who accessed the survey, 175 (83%) completed the survey. Respondents reported a universal decrease in clinical activities (98.3%). Among participants who felt their program utilized technology well, there were significantly decreased concerns to receiving adequate educational knowledge (29.6% vs 65.2%, P = .003). However, 68% of trainees still expressed concern in ability to receive adequate surgical training. In addition, 54.7% of senior trainees felt that the pandemic had a negative impact on their ability to secure a job or fellowship after training.

CONCLUSIONS

Trainees universally felt a negative impact due to the COVID-19 pandemic. Use of technology was able to alleviate some concerns in gaining adequate educational knowledge, but decreased surgical training remained the most prevalent concern.