The Good, the Bad, and the Ugly of the COVID-19 Pandemic in a Urology Residency Program in Singapore.

To the Editor

The COVID-19 pandemic has affected Residency training worldwide in an unprecedented fashion.1, 2, 3 Residency Programs have been abruptly asked to respond in innovative and dynamic ways in the face of the pandemic. We share important lessons and insights about the impact on a Urology Residency Program in an Academic Medical Center in Singapore. We focus our discussion around the Academic, Administrative, Professional, and Personal Developmental aspects of Residency training.

The “Good”

Academically, this crisis has presented a perfect opportunity to revisit fundamentals on disease pathophysiology and natural history. Due to the need to prioritize resources, residents were challenged to examine the necessity of certain treatment procedures, and the expected natural history if treatment was delayed. Residents even developed guidelines and clinical decision-making tools for prioritizing surgical cases. Residents also dedicated more time “paying-it-forward” by teaching undergraduates who similarly transited to virtual-learning, thereby consolidating their own knowledge.

Administratively, Residents participated actively in streamlining departmental protocols for the management of common urological conditions during the pandemic. This was achieved mainly through the expansion of our Tele-consultation services. Interprofessional learning was evident with closer interaction with Primary Care colleagues to streamline management pathways, and stronger linkages with other frontline disciplines to provide patient-centric healthcare.

Professionally, we observed significantly closer mentorship by Faculty as cases were meticulously reviewed. Faculty and Residents demonstrated adaptability while under pressure to defer elective cases. Compared to routine clinics or ward rounds, several-fold more cases were discussed. An interesting observation was that Attendings managed to share clinical pearls and insights for seemingly “routine” and “straightforward” cases, further benefiting Residents in their learning.

The “Bad”

Academically, patient caseload reduced significantly, for the greater good of resource distribution for COVID-19 patients. Emergency Urological operations remained constant but elective operations reduced by 70% within 2 months. This had significant impact on Residents’ case-logs, with mandatory training requirements at risk of being unfulfilled. Reduced surgical exposure was partly overcome by simulation and virtual-learning of procedures.

Administratively, cross-hospital clinical rotations were restricted to reduce risks of cross-contamination. Furthermore, incoming residents were at risk of missing the commencement of Residency at our institution. This was circumvented with coordinated Ministry of Health efforts, supported by nationwide sponsoring Programs, to ensure that Residents could fulfil required clinical rotations regardless of the hospitals they were based at.

Professionally, physical team segregation has caused significantly reduced social interaction. Yet, through virtual-means, strong camaraderie remained strong within, and across, teams. Residents also had precious opportunities for longer apprenticeships with Attendings, compared to what normal-length subspecialty rotations would typically allow.

The “Ugly”

Personally, each healthcare professional faces an “ugly” possibility of contracting COVID-19, and more significantly, have placed our loved-ones at risk of transmission as well. Yet, we are grateful for, and galvanized by, supportive families and the wider society.

Amid challenging circumstances, Residents have grown academically, administratively, professionally, and personally. As Residents, our resolve has never been stronger to overcome this pandemic with the global medical community.

Author Contributions

Yi Quan Tan: Conceptualization, Writing - original draft. Ziting Wang: Conceptualization, Writing - review & editing. Ho Yee Tiong: Conceptualization, Writing - review & editing. Edmund Chiong: Conceptualization, Writing - review & editing, Supervision.