Amanda C Purdy1, Christian de Virgilio1, Amy H Kaji2,3, Edgar Shields Frey4, Steven Lee-Kong5, Kenji Inaba6, Jeffrey M Gauvin7, Angela L Neville1, Timothy R Donahue8, Brian R Smith9, Edgardo S Salcedo10, Kristine E Calhoun11, V Prasad Poola12, Jukes P Namm13, David A Spain14, Karen J Dickinson15, Tiffany Tanner16, Mary Wolfe17, Farin Amersi18. 1. Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance. 2. Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance. 3. Statistical Editor, JAMA Surgery. 4. Department of Surgery, Brookwood Baptist Medical Center, Birmingham, Alabama. 5. Department of Surgery, Columbia University Medical Center, New York, New York. 6. Department of Surgery, University of Southern California/Los Angeles County Medical Center, Los Angeles. 7. Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California. 8. Department of Surgery, University of California, Los Angeles Health, Los Angeles. 9. Department of Surgery, University of California, Irvine, Medical Center, Orange. 10. Department of Surgery, University of California, Davis, School of Medicine, Sacramento. 11. Department of Surgery, University of Washington Medical Center, Seattle. 12. Department of Surgery, Southern Illinois School of Medicine, Springfield. 13. Department of Surgery, Loma Linda University Health, Loma Linda, California. 14. Department of Surgery, Stanford University, Stanford, California. 15. Department of Surgery, Houston Methodist Hospital, Houston, Texas. 16. Department of Surgery, University of Nebraska Medical Center, Omaha. 17. Department of Surgery, University of California, San Francisco, at Fresno, Fresno. 18. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Abstract
Importance: The suspension of elective operations in March 2020 to prepare for the COVID-19 surge posed significant challenges to resident education. To mitigate the potential negative effects of COVID-19 on surgical education, it is important to quantify how the pandemic influenced resident operative volume. Objective: To examine the association of the pandemic with general surgical residents' operative experience by postgraduate year (PGY) and case type and to evaluate if certain institutional characteristics were associated with a greater decline in surgical volume. Design, Setting, and Participants: This retrospective review included residents' operative logs from 3 consecutive academic years (2017-2018, 2018-2019, and 2019-2020) from 16 general surgery programs. Data collected included total major cases, case type, and PGY. Faculty completed a survey about program demographics and COVID-19 response. Data on race were not collected. Operative volumes from March to June 2020 were compared with the same period during 2018 and 2019. Data were analyzed using Kruskal-Wallis test adjusted for within-program correlations. Main Outcome and Measures: Total major cases performed by each resident during the first 4 months of the pandemic. Results: A total of 1368 case logs were analyzed. There was a 33.5% reduction in total major cases performed in March to June 2020 compared with 2018 and 2019 (45.0 [95% CI, 36.1-53.9] vs 67.7 [95% CI, 62.0-72.2]; P < .001), which significantly affected every PGY. All case types were significantly reduced in 2020 except liver, pancreas, small intestine, and trauma cases. There was a 10.2% reduction in operative volume during the 2019-2020 academic year compared with the 2 previous years (192.3 [95% CI, 178.5-206.1] vs 213.8 [95% CI, 203.6-223.9]; P < .001). Level 1 trauma centers (49.5 vs 68.5; 27.7%) had a significantly lower reduction in case volume than non-level 1 trauma centers (33.9 vs 63.0; 46%) (P = .03). Conclusions and Relevance: In this study of operative logs of general surgery residents in 16 US programs from 2017 to 2020, the first 4 months of the COVID-19 pandemic was associated with a significant reduction in operative experience, which affected every PGY and most case types. Level 1 trauma centers were less affected than non-level 1 centers. If this trend continues, the effect on surgical training may be even more detrimental.
Importance: The suspension of elective operations in March 2020 to prepare for the COVID-19 surge posed significant challenges to resident education. To mitigate the potential negative effects of COVID-19 on surgical education, it is important to quantify how the pandemic influenced resident operative volume. Objective: To examine the association of the pandemic with general surgical residents' operative experience by postgraduate year (PGY) and case type and to evaluate if certain institutional characteristics were associated with a greater decline in surgical volume. Design, Setting, and Participants: This retrospective review included residents' operative logs from 3 consecutive academic years (2017-2018, 2018-2019, and 2019-2020) from 16 general surgery programs. Data collected included total major cases, case type, and PGY. Faculty completed a survey about program demographics and COVID-19 response. Data on race were not collected. Operative volumes from March to June 2020 were compared with the same period during 2018 and 2019. Data were analyzed using Kruskal-Wallis test adjusted for within-program correlations. Main Outcome and Measures: Total major cases performed by each resident during the first 4 months of the pandemic. Results: A total of 1368 case logs were analyzed. There was a 33.5% reduction in total major cases performed in March to June 2020 compared with 2018 and 2019 (45.0 [95% CI, 36.1-53.9] vs 67.7 [95% CI, 62.0-72.2]; P < .001), which significantly affected every PGY. All case types were significantly reduced in 2020 except liver, pancreas, small intestine, and trauma cases. There was a 10.2% reduction in operative volume during the 2019-2020 academic year compared with the 2 previous years (192.3 [95% CI, 178.5-206.1] vs 213.8 [95% CI, 203.6-223.9]; P < .001). Level 1 trauma centers (49.5 vs 68.5; 27.7%) had a significantly lower reduction in case volume than non-level 1 trauma centers (33.9 vs 63.0; 46%) (P = .03). Conclusions and Relevance: In this study of operative logs of general surgery residents in 16 US programs from 2017 to 2020, the first 4 months of the COVID-19 pandemic was associated with a significant reduction in operative experience, which affected every PGY and most case types. Level 1 trauma centers were less affected than non-level 1 centers. If this trend continues, the effect on surgical training may be even more detrimental.
Authors: Saba Balvardi; Koorosh Semsar-Kazerooni; Pepa Kaneva; Carmen Mueller; Melina Vassiliou; Mohammed Al Mahroos; Julio F Fiore; Kevin Schwartzman; Liane S Feldman Journal: Surg Endosc Date: 2022-08-03 Impact factor: 3.453
Authors: Elena Abati; Leonardo Nelva Stellio; Arianna Manini; Francesco Moroni; Lorenzo Azzalini; Luz Maria Vilca Journal: Ann Med Date: 2022-12 Impact factor: 5.348
Authors: Joshua G Kovoor; Georgia R Layton; Joshua R Burke; James A Churchill; Jonathan Henry W Jacobsen; Jessica L Reid; Suzanne Edwards; Eyad Issa; Tamsin J Garrod; Julian Archer; David R Tivey; Wendy J Babidge; Ashley R Dennison; Guy J Maddern Journal: ANZ J Surg Date: 2022-08-18 Impact factor: 2.025