Impact of COVID-19 on a plastic surgery residency education program: Outcomes of a survey.

Dear Sir,

The COVID-19 pandemic has impacted plastic surgery residency education worldwide. The current situation demands a critical evaluation of the traditional plastic surgery residency education model, as well as the need for alternative learning methods that will help deliver high-quality education for residents while maintaining their safety. Numerous strategies have been implemented to optimize education and well-being: team restructuring, clinical reassignment, reduced hospital visits and creation of virtual curriculums.1, 2, 3, 4, 5

In May-June 2020, we surveyed residents and attendings in the Division of Plastic Surgery at Mayo Clinic Rochester regarding the impact of COVID-19 on their training/career and personal lives and their satisfaction with our virtual curriculum. Twenty-one responses from 13 residents and 8 attendings (72.4% response rate) were collected, Figure 1 .

Figure 1

Survey results.

Clinical service structure

Our division implemented a small-team approach during the pandemic which consisted of three teams, each composed of a PGY 2–6 resident and a consultant. The aim was to limit unnecessary exposure and interaction with other personnel and patients while assuring coverage of the entire service. Each team worked one week at the hospital followed by two weeks at home engaging in virtual educational activities. Overall, 38.1% of respondents experienced challenges during in-person patient encounters as a result of pandemic-related changes; 57.1% reported successful telehealth encounters.

Virtual learning

With the implementation of social distancing measures, in-person educational conferences were suspended. Our educational program transitioned to a virtual curriculum that consisted of both Virtual Grand Rounds Series organized by plastic surgery societies and our institution's specific conferences, with options for group-based and independent learning. Each week was organized around one theme and a resident team was in charge of organizing cases, journal articles, research discussions and questions/basic science lecture for the core curriculum. In addition, virtual sessions for promotion of mental and physical well-being were also available. In a matter of four weeks, 64 virtual sessions were included in our curriculum which consisted of 24 Virtual Grand Rounds, 8 hand conferences, 7chapter and case discussions, 4 core curriculums, 3 journal clubs, 2 M&M conferences, and 2 visiting professor lectures, Table 1 . Attendance at these virtual conferences was higher than normal, with positive reviews from faculty and attendees.

Table 1

Sample weekly schedule of our virtual curriculum during COVID-19.

Date	Time	Conference	Topic
20-Apr	7–7:50 am	Hand Education	Finger Arthritis: Evaluation & Management (DIP, PIP, MCP Joints)
20-Apr	11–12 pm	ASPS Virtual Grand Rounds	Why/How Social Media is Transforming Plastic Surgery - Don't Blink
20-Apr	2–3 pm	Visiting Professor Presentation	Quick Recovery Breast Augmentation & Essentials in Rhinoplasty
20-Apr	6–7 pm	Journal Club	Selected articles
21-Apr	12–1 pm	Virtual Anatomy Online Session	Vasculatures of the Face and Respective Danger Zones
21-Apr	2–3:30 pm	Journal Club - PRS	Selected articles
22-Apr	10–11 am	AO CMF Virtual Grand Rounds	Pediatric Trauma
22-Apr	11–12 pm	ASPS Virtual Grand Rounds	Upper Extremity Nerve Transfers
22-Apr	2–3 pm	Chapter & Case Discussions	Volume 4, Chapter 18 Acute Management of burn and electrical trauma and Chapter 21 Burn reconstruction
23-Apr	2–3:30 pm	Core Curriculum	Gynecomastia
23-Apr	7–8 pm	AO Hand Virtual Grand Rounds	Distal Tendon Avulsions: Mallet & Jersey Fingers/VY Flap & Moberg Flap
24-Apr	7–7:50 am	Orthopedics Hand Conference	PIP Arthrodesis vs Arthroplasty
24-Apr	11–12 pm	ASJ Virtual Grand Rounds	Patient Safety & VTE

ASPS: American Society of Plastic Surgeons; PRS: Plastic and Reconstructive Surgery; AO CMF: AO cranio-maxillofacial; ASJ: Aesthetic Surgery Journal.

In our survey, respondents ranked education as their top priority during the pandemic, followed by family/ friends, career, mental/physical wellbeing and research. A high percentage of participants suggested that virtual meetings should be continued after the pandemic and used for clinical cases discussion, research discussions, research conferences and surgical technique education. Having a structured curriculum is helpful since the majority of residents follow the residency conference didactics schedule. Even though the virtual curriculum was implemented for continuation of residency education during COVID-19, it has changed the future of residency training. Virtual learning will enhance the residency education and complement the traditional in-person format. Improved technology will allow for higher quality virtual meetings, simulation-based training, virtual reality, and virtual patient consultations using telemedicine. A high percentage of participants in our study believed that the virtual curriculum should be implemented as a model for future natural disasters. With the help of leaders, a well-structured and flexible educational model that is readily available in case of future emergencies should be implemented.

Physical and mental wellbeing

The impact of COVID-19 on mental health is undeniable. , The uncertainty and novelty of this situation creates anxiety and stress that affects trainees’ daily lives and those of their family and friends. Thus, activities to promote physical and mental wellbeing are paramount. Deployment creates additional stress and burn-out, and staff working from home might not be as productive as in the hospital. Leaders should be mindful of the impact on wellbeing and provide time for residents and faculty to adapt to this unprecedented situation. In our study, one third of participants agreed that COVID-19 impacted their training/career and their relationship with family/friends, 76.2% changed their family or travel plans. However, 61.9% disagreed that COVID-19 affected their physical health, or mental health (52.4%). Some of the reasons that could explain the lesser impact on wellbeing of our staff compared to other reports during COVID-19 could be that our program implemented early changes to adapt to the pandemic, that residents were not deployed, and that early and continuous communication was maintained between leaders and residents. We also organized trivia nights that allowed residents to connect with each other during this crisis. In addition, our institution prepared several virtual meetings to address wellbeing during the pandemic.

We hope to provide insight to our personal educational model that has shown to have high rates of satisfaction. We believe that this model allows for a continuation of residency education while allowing professional, social and personal growth during unexpected circumstances such as COVID-19. As the battle against COVID-19 continues, residency programs must develop an education model that assures high-quality education delivery while keeping our personnel safe.

Author contributions

All authors contributed in the study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript and critical revision.

Disclosure statement

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

N/A.