Lessons to learn from COVID redeployment: Should ITU experience be introduced into all future Burns Surgeons training?

The 2020 COVID-19 pandemic has changed the shape of current and possibly future surgical training in the UK. With reduction in service provision across both emergency and elective sites and redeployment to frontline roles, surgical trainees experience this year has been very different from their senior counterparts. Due to the halting of elective plastic surgery activity, redeployment of plastic and burns surgeons throughout the pandemic became commonplace across the UK [1,2].

In the experience of our burns centre, we truly saw a department-wide front-line redeployment in support of the COVID effort. Throughout the pandemic our burns consultants led a tracheostomy group in order to address the need of COVID patients requiring this procedure, operating jointly alongside groups of other qualified consultants. All the junior staff below registrar level was also redeployed to support the workload of the intensive care unit.

In many surgical training schemes around the world, including Australia and the United States of America, junior surgeons spend a dedicated period of time during their surgical training in the intensive care unit [3]. In the United Kingdom, prior to the restructuring of core surgical training, basic surgical trainees also typically undertook a period of training in either the emergency department or the intensive care unit. The subsequent streamlining of surgical training was seen as having many advantages to trainees; including faster progression to consultancy and preventing trainees spending time in a speciality which they do not want to practice.

With three months of previous foundation intensive care training behind me, I was recognised early as a trainee that could easily be redeployed to support the ITU effort. After having completed my three month period of redeployment, I subsequently moved to working as a registrar in a burns centre with dedicated intensive care beds. I now recognise the numerous transferable skills I obtained that enable me to feel confident in working alongside the critical care team managing the major resuscitation burns on ITU. During this time I learnt about ventilation strategies and management of critically unwell ARDS patients, and gained confidence in airway management of intubated and tracheotomised patients, both in the supine and prone position. I also improved my understanding of fluid balance strategies and renal replacement therapies, and learnt new skills of central vascular access. Most notably I developed a foundation and approach to communicating critical events and bad news to families, both in person and by telephone, a skill I feel is truly transferable to all surgical specialties.

Whilst I recognise the skills gained during the COVID pandemic in redeployment as invaluable to burns trainees, incorporating this into all plastic surgery specialty training may be challenging. Some colleagues may be deterred by the extra time which would be required, or feel that they are losing out on operative experience and potentially deskill. It may therefore be most useful to incorporate this at either a junior level, i.e. during core surgical training, or at a more senior level, i.e. burns fellowships, to prevent the effect of this attrition of skills. It is clear that the redeployment of plastic surgery trainees during the COVID-19 pandemic posed an unprecedented challenge in terms of stress, surgical training and plastic surgery service provision. However, it should now be viewed as a milestone for reflection, with the aim that as a specialty we can use our experiences to shape and develop the training of our future surgeons.

Conflict of interest

The authors declare no conflict of interest for this work.