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

Abstract

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.

Graphical abstract

Figure 1

ACGME stage and regional distribution. Stage 1(n = 98 [22%]): business as usual; stage 2 (n = 214 [48%]): increasing but manageable; stage 3 (n = 135 [30%]): crossing the threshold. There were 447 respondents from the US. The graph shows the distribution of stage by region. There were 15 respondents from other locations—9 from Canada and 6 from other locations outside the US. In addition, 10 respondents skipped the question on location of primary institution and stage.

Figure 2

Proportion of respondents reporting severe reductions in nonemergency and emergency operative volume. Nonemergency operative volume, stage 1 vs stage 3: odds ratio (OR) 0.43; p < 0.0001; 95% CI, 0.010 to 0.189; stage 2 vs stage 3: OR 0.103; p = 0.0022; 95% CI, 0.024 to 0.441. Emergency operative volume, stage 1 vs stage 3: OR 0.175; p = 0.001; 95% CI, 0.075 to 0.413; stage 2 vs stage 3: OR 0.372; p = 0.0003; 95% CI, 0.218 to 0.632.

Figure 3

Severe impact on didactic education by ACGME stage. Stage 1: business as usual; stage 2: increasing but manageable; stage 3: crossing the threshold. Stage 1 vs stage 3: OR 0.192; p < 0.0001; 95% CI, 0.095 to 0.388; stage 2 vs stage 3: OR 0.507; p = 0.0041; 95% CI, 0.319 to 0.806.