Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large U.S. Academic Medical Center

Abstract

Background: The coronavirus disease 2019 pandemic has led to sweeping changes in residency programs across the world, including cancellation of elective cases. The effects of safety measures on neurosurgical training remain unclear. To understand how neurosurgical residents have been affected, we analyzed the operative experience in the months leading up to and during the pandemic.

Methods: The resident and institutional case totals were tallied for a single residency program in Miami-Dade County from January 1, 2019 to June 30, 2020. A matched cohort analysis was performed before and during the pandemic to assess the effects on resident surgical training.

Results: The case totals for all levels of training were lower when restrictions were placed on elective surgeries. An average of 11 cases was logged in April 2020, a decrease from 26 cases in April 2019 (95% confidence interval, 8.7-22; P < 0.01). An average of 20 cases was logged in May 2020, a decrease from 25 cases in May 2019 (95% confidence interval, 1.2-8.8; P = 0.01). In April and May 2020, 299 (66%) and 148 (50%) fewer cases had been performed at our institution compared with April and May 2109.

Conclusions: Operative experience was reduced for residents during the months when the performance of elective cases was restricted. Our data suggest experience in some areas of neurosurgery were more affected than were others, and residents at different levels of training were also affected differently. However, the extent of the coronavirus disease 2019 pandemic on neurosurgical training is unlikely to be understood in the short term.

Keywords: COVID-19; Operative; Pandemic; Residency; Surgery; Training.

Figure 1

Schematic of resident rotation adjustments during peak pandemic months at our institution. Three subservices at the main county hospital were merged into one service that covered inpatient care and consultations. Other residents performed rounds on their services and covered cases only as needed. At the university hospital, the daily covering team was reduced by one half. These changes allowed ≥1 resident per class to be relieved of clinical duty each week to reduce their exposure to coronavirus disease 2019 (Covid). ICU, intensive care unit; PGY, postgraduate year; VA, vascular.

Figure 2

(A) Average cases logged stratified by resident postgraduate year (PGY) from January to June in 2019 and 2020. During the study period, the highest case totals were noted for PGY-6 and PGY-7 residents. Lower case totals for all levels of training were noted for all rotations in April 2020. (B) With the exception of spine service PGY-7 residents, all residents had also recorded fewer cases for May 2020.