Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents

Background and objectives

Training in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain.

Methods

A cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearson’s Chi-square test (χ2) with Yates’s correction and Pearson's correlation coefficient (r) were used.

Results

143 completed surveys were received from 264 Residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalisation (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (p < 0.05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty.

Conclusions

The decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Contagion mainly occurred through contact with asymptomatic carriers during patient care and through supposedly close contact with asymptomatic carriers. Virtual activities have been widely accepted, but they have not completely replaced all residents’ training needs. Measures should be implemented to recover lost training, especially surgical practical learning in otology and rhinology.

[Impact Of The Covid-19 Pandemic On The Training Of Otorhinolaryngology Residents]

Antecedentes y objetivos

La pandemia COVID-19 ha alterado todas las actividades sanitarias, entre ellas la formación especializada de los residentes. Se llevó a cabo un estudio para analizar en profundidad el impacto de la pandemia COVID-19 en aspectos específicos de las actividades clínicas, formativas e investigadoras que realizan los residentes de otorrinolaringología (ORL) en España durante un año completo de formación.

Métodos

Se realizó un estudio cualitativo transversal durante las últimas dos semanas de febrero de 2021. El estudio consistió en una encuesta en línea realizada por residentes de ORL que habían realizado un año continuado de formación desde el 15 de febrero de 2020 al 15 de febrero de 2021 y consistió en 26 preguntas que exploraban el impacto del COVID-19 en la salud de los residentes de ORL, en su dedicación laboral y en las actividades de formación. Las variables categóricas se informaron como frecuencia y porcentaje. Cuando se indicó, se utilizó la prueba chi-cuadrado de Pearson con la corrección de Yates y el coeficiente de correlación de Pearson (r).

Resultados

Se recibieron 143 encuestas cumplimentadas de 264 residentes (54,17%). Treinta y seis residentes (25,2%) habían padecido la enfermedad por SARS-CoV-2. La mayoría de ellos solo desarrollaron síntomas leves (86,1%) y 3 requirieron hospitalización (8,3%). Los residentes encuestados que resultaron positivos para SARS-CoV-2 no fueron capaces de identificar la fuente de su contagio y la necesidad de confinamiento se debió principalmente a la atención de un paciente asintomático en 9 casos (6,3%) o al contacto estrecho con un asintomático en situaciones no identificadas distintas de la atención sanitaria en 22 (15,4%). El 60,1% de los residentes encuestados reportaron haber perdido más de 6 meses de su período de formación, y en el 18,8% de los casos llegaron a 10 y 12 meses. Se ha producido una reducción de más del 75% de lo previsto en formación quirúrgica (p < 0,05) de timpanoplastia, mastoidectomía, estapedectomía, implantes cocleares, cirugía endoscópica nasosinusal y de base de cráneo anterior, septoplastia y turbinoplastia.

Conclusiones

El descenso de la actividad ORL y la necesidad de prestar asistencia en otros servicios y unidades durante los momentos más críticos de la pandemia han causado la principal reducción de su capacidad de formación. El contagio fundamentalmente ocurrió por el contacto con portadores asintomáticos durante la atención a pacientes y por contacto estrecho con portadores asintomáticos. Las actividades virtuales han sido ampliamente aceptadas, pero no han reemplazado por completo las necesidades de formación de todos los residentes. Se deberán implementar medidas para recuperar la formación perdida, especialmente el aprendizaje práctico quirúrgico en otología y rinología.

[Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.

Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery for performing tracheotomies in patients infected by the coronavirus, Covid-19

The recent COVID-19 (coronavirus) pandemic is causing an increase in the number of patients who, due to their pulmonary ventilatory status, may require orotracheal intubation. COVID-19 infection has demonstrated a high rate of transmissibility, especially via the respiratory tract and by droplet spread. The Spanish Society of Otolaryngology and Head and Neck Surgery, based on the article by Wei et al. of 2003 regarding tracheotomies performed due to severe acute respiratory syndrome (SARS), has made a series of recommendations for the safe performance of tracheotomies.

Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery for Performing Tracheotomies in Patients Infected by the Coronavirus, Covid-19

The recent COVID-19 (coronavirus) pandemic is causing an increase in the number of patients who, due to their pulmonary ventilatory status, may require orotracheal intubation. COVID-19 infection has demonstrated a high rate of transmissibility, especially via the respiratory tract and by droplet spread. The Spanish Society of Otolaryngology and Head and Neck Surgery, based on the article by Wei et al. (2003) regarding tracheotomies performed due to severe acute respiratory syndrome (SARS), has made a series of recommendations for the safe performance of tracheotomies.

Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

Executive summary of the SEORL CCC-SEEN consensus statement on post-thyroidectomy hypoparathyroidism

Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria.