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Hey HWD, Tay HW, Bosco A, Soh RCC, Oh JYL. Impact of COVID-19 on orthopaedic specialist training: a nationwide survey of orthopaedic residents in Singapore. Singapore Med J 2024; 65:S56-S62. [PMID: 35083908 PMCID: PMC11073654 DOI: 10.11622/smedj.2022013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Hwee Weng Dennis Hey
- Department of Orthopaedic Surgery, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Wen Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aju Bosco
- Orthopaedic Spine Surgery Unit, Madras Medical College and Research Institute, Chennai, Tamil Nadu, India
| | | | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Alvarenga GFD, Nogueira Leite AK, Lehn CN, Dedivitis RA, Yumi Nakai M, Cavalheiro BG, Vaz Teixeira G, De Cicco R, Kowalski LP, Matos LLD. Impact of the COVID-19 Pandemic on Brazilian Head and Neck Surgery Centers. Braz J Otorhinolaryngol 2023; 89:456-461. [PMID: 36803803 PMCID: PMC9884113 DOI: 10.1016/j.bjorl.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/13/2022] [Accepted: 01/19/2023] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers. METHODS An anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April‒June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020. RESULTS The response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n=19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly. CONCLUSIONS The COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment. LEVEL OF EVIDENCE Evidence from a single descriptive study.
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Affiliation(s)
| | - Ana Kober Nogueira Leite
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Carlos Neutzling Lehn
- Hospital do Servidor Público Estadual, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | | | - Marianne Yumi Nakai
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Beatriz Godoi Cavalheiro
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil,Instituto Brasileiro de Controle do Câncer, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Gilberto Vaz Teixeira
- Centro de Pesquisas Oncológicas, Departamento de Cirurgia de Cabeça e Pescoço, Florianópolis, RS, Brazil,Universidade Federal de Santa Catarina, Faculdade de Medicina, Departamento de Cirurgia, Florianópolis, RS, Brazil
| | - Rafael De Cicco
- Instituto do Câncer Doutor Arnaldo Vieira de Carvalho, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Leandro Luongo de Matos
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil,Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
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Krishnan PS, Daggumati S, Widmeyer J, Quinn KJ, Yu C, Vahidi N, Kamdar R, Kandl C. The Lasting Impact of the COVID-19 Pandemic on Surgical Key Indicator Cases for Otolaryngology Residency Education. Ann Otol Rhinol Laryngol 2022:34894221123121. [PMID: 36123958 DOI: 10.1177/00034894221123121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Early on during the COVID-19 pandemic, the US Centers for Medicare & Medicaid Services (CMS) and other government as well as medical institutions recommended that surgeons postpone nonessential surgeries. The aim of our study is to examine the impact of the COVID-19 pandemic on otolaryngology surgical training by evaluating changes in surgical volumes through various time points relative to the height of the pandemic. METHODS We performed a retrospective review of all surgical cases performed by the Otolaryngology-Head and Neck Surgery department at a tertiary care academic center from 3 time periods: July 1st, 2018, to June 30th, 2019; July 1st, 2019, to June 30th, 2020; and July 1st, 2020, to June 30th, 2021. RESULTS From the 2018-19 period to the 2020-21 period, the total number of overall cases decreased by 9.9%, from 2386 to 2148 cases. During this same time duration, the number of key indicator cases decreased by 13.4%, from 1715 to 1486 cases. Relative to other cases, ethmoidectomy, rhinoplasty, and stapes/OCR cases decreased the most during the 2019-20 period by 41.9%, 41.8%, and 29.5%, respectively. From the 2018-19 period to the 2020-21 period, thyroid/parathyroid cases decreased the most by 35.4%. Only ethmoidectomy and oral cavity cases showed increases during this period at 9.7% and 24.4%, respectively. CONCLUSIONS Although case volumes have stayed relatively constant, key indicator case volumes at the present tertiary care academic center have not yet fully recovered from the COVID-19 pandemic. Efforts must be made to determine how this has impacted residency surgical education.
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Affiliation(s)
- Pavan S Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Srihari Daggumati
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Jonathan Widmeyer
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Kevin J Quinn
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Cheryl Yu
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Nima Vahidi
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Rushabh Kamdar
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Christopher Kandl
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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Lahelma M, Oksanen L, Rantanen N, Sinkkonen S, Aarnisalo A, Geneid A, Sanmark E. Aerosol Generation During Otologic Surgery. Otol Neurotol 2022; 43:924-930. [PMID: 35900917 PMCID: PMC9394486 DOI: 10.1097/mao.0000000000003591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether aerosol generation occurs during otologic surgery, to define which instruments are aerosol generating, and to identify factors that enhance safety in protection against airborne pathogens, such as severe acute respiratory syndrome coronavirus 2. STUDY DESIGN An observational prospective study on aerosol measurements during otologic operations recorded between August and December 2020. SETTING Aerosol generation was measured with an Optical Particle Sizer as part of otologic operations with anesthesia. Particles with a size range of 0.3 to 10 μm were quantified. Aerosol generation was measured during otologic operations to analyze aerosols during drilling in transcanal and transmastoid operations and when using the following instruments: bipolar electrocautery, laser, suction, and cold instruments. Coughing is known to produce significant concentration of aerosols and is commonly used as a reference for high-risk aerosol generation. Thus, the operating room background concentration and coughing were chosen as reference values. PATIENTS Thirteen otologic operations were included. The average drilling time per surgery was 27.00 minutes (range, 2.00-71.80 min). INTERVENTION Different rotation speeds during drilling and other instruments were used. MAIN OUTCOME MEASURES Aerosol concentrations during operations were recorded and compared with background and cough aerosol concentrations. RESULTS Total aerosol concentrations during drilling were significantly higher than background ( p < 0.0001, d = 2.02) or coughing ( p < 0.0001, d = 0.50). A higher drilling rotation speed was associated with higher particle concentration ( p = 0.037, η2 = 0.01). Aerosol generation during bipolar electrocautery, drilling, and laser was significantly higher than with cold instruments or suction ( p < 0.0001, η2 = 0.04). CONCLUSION High aerosol generation is observed during otologic surgery when drill, laser, or bipolar electrocautery is used. Aerosol generation can be reduced by using cold instruments instead of electric and keeping the suction on during aerosol-generating procedures. If drilling is required, lower rotation speeds are recommended. These measures may help reduce the spread of airborne pathogens during otologic surgery.
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Affiliation(s)
- Mari Lahelma
- Faculty of Medicine, University of Helsinki
- Department of Otorhinolaryngology and Phoniatrics–Head and Neck Surgery, Helsinki University Hospital
- Faculty of Science, Mathematics, and Statistics, University of Helsinki, Helsinki, Finland
| | - Lotta Oksanen
- Faculty of Medicine, University of Helsinki
- Department of Otorhinolaryngology and Phoniatrics–Head and Neck Surgery, Helsinki University Hospital
| | - Noora Rantanen
- Faculty of Medicine, University of Helsinki
- Department of Otorhinolaryngology and Phoniatrics–Head and Neck Surgery, Helsinki University Hospital
| | - Saku Sinkkonen
- Faculty of Medicine, University of Helsinki
- Department of Otorhinolaryngology and Phoniatrics–Head and Neck Surgery, Helsinki University Hospital
| | - Antti Aarnisalo
- Faculty of Medicine, University of Helsinki
- Department of Otorhinolaryngology and Phoniatrics–Head and Neck Surgery, Helsinki University Hospital
| | - Ahmed Geneid
- Faculty of Medicine, University of Helsinki
- Department of Otorhinolaryngology and Phoniatrics–Head and Neck Surgery, Helsinki University Hospital
| | - Enni Sanmark
- Faculty of Medicine, University of Helsinki
- Department of Otorhinolaryngology and Phoniatrics–Head and Neck Surgery, Helsinki University Hospital
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Givi B, Gordon AJ, Park YS, Lydiatt WM, Tekian A. Needs assessment in head and neck surgical oncology training: A qualitative study of expert opinions. Head Neck 2022; 44:2528-2536. [PMID: 35920353 DOI: 10.1002/hed.27158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/15/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Few studies have investigated the needs of head and neck surgery trainees and areas for improvement of fellowship programs. METHODS We conducted a qualitative study by interviewing a nationally representative sample of program directors and national leaders in head and neck surgery. We asked about the current state and strengths of training; and areas for further improvement. All interviews were independently coded and analyzed by two reviewers. RESULTS All experts (100%) believed that the current training provides a strong foundation and furthermore, a standardized curriculum is beneficial. Multidisciplinary training (80%), participation in tumor boards (75%), and a syllabus (60%) were the most frequently mentioned components. Most believed that a formal certification process would be beneficial (73%), though there was no consensus on the format. CONCLUSION Experts in head and neck surgery are generally in favor of a standardized curriculum. Further discussions of a formal certification process might be warranted.
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Affiliation(s)
- Babak Givi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Alex J Gordon
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois Chicago, Chicago, Illinois, USA
| | - William M Lydiatt
- Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Ara Tekian
- Department of Medical Education, University of Illinois Chicago, Chicago, Illinois, USA
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Young K, Yeoh SA, Putman M, Sattui S, Conway R, Graef E, Kilian A, Konig M, Sparks J, Ugarte-Gil M, Upton L, Berenbaum F, Bhana S, Costello W, Hausmann J, Machado P, Robinson P, Sirotich E, Sufka P, Yazdany J, Liew J, Grainger R, Wallace Z, Jayatilleke A. The Impact of Covid-19 on rheumatology training - Results from the COVID-19 Global Rheumatology Alliance trainee survey. Rheumatol Adv Pract 2022; 6:rkac001. [PMID: 35392427 PMCID: PMC8982766 DOI: 10.1093/rap/rkac001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Objective The aim was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical experiences, research opportunities and well-being of rheumatology trainees. Methods A voluntary, anonymous, Web-based survey was administered in English, Spanish or French from 19 August 2020 to 5 October 2020. Adult and paediatric rheumatology trainees were invited to participate via social media and email. Using multiple-choice questions and Likert scales, the perceptions of trainees regarding the impact of the COVID-19 pandemic on patient care and redeployment, learning and supervision, research and well-being were assessed. Results There were 302 respondents from 33 countries, with 83% in adult rheumatology training. An increase in non-rheumatology clinical work was reported by 45%, with 68% of these having been redeployed to COVID-19. Overall, trainees reported a negative impact on their learning opportunities during rheumatology training, including outpatient clinics (79%), inpatient consultations (59%), didactic teaching (55%), procedures (53%), teaching opportunities (52%) and ultrasonography (36%). Impacts on research experiences were reported by 46% of respondents, with 39% of these reporting that COVID-19 negatively affected their ability to continue their pre-pandemic research. Burnout and increases in stress were reported by 50% and 68%, respectively. Physical health was negatively impacted by training programme changes in 25% of respondents. Conclusion The COVID-19 pandemic has had a substantial impact on rheumatology training and trainee well-being. Our study highlights the extent of this impact on research opportunities and clinical care, which are highly relevant to future curriculum planning and the clinical learning environment.
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Affiliation(s)
- Kristen Young
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Su-Ann Yeoh
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Michael Putman
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Sebastian Sattui
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Richard Conway
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Elizabeth Graef
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Adam Kilian
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Maximilian Konig
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jeffrey Sparks
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Manuel Ugarte-Gil
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Laura Upton
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Francis Berenbaum
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Suleman Bhana
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Wendy Costello
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jonathan Hausmann
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Pedro Machado
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Philip Robinson
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Emily Sirotich
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Paul Sufka
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jinoos Yazdany
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Jean Liew
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Rebecca Grainger
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Zachary Wallace
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
| | - Arundathi Jayatilleke
- Temple University School of Medicine, 3322 N Broad St, Suite 201, Philadelphia, PA, United States of America
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Maharjan P, Alsadoon A, Prasad PWC, Al-Khalil AB, Jerew OD, Alsadoon G, Chapagain B. An enhanced algorithm for improving real-time video transmission for tele-training education. MULTIMEDIA TOOLS AND APPLICATIONS 2022; 81:8409-8428. [PMID: 35125927 PMCID: PMC8809212 DOI: 10.1007/s11042-022-12045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/25/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
Tele-training in surgical education has not been effectively implemented. There is a stringent need for a high transmission rate, reliability, throughput, and reduced distortion for high-quality video transmission in the real-time network. This work aims to propose a system that improves video quality during real-time surgical tele-training. The proposed approach aims to minimise the video frame's total distortion, ensuring better flow rate allocation and enhancing the video frames' reliability. The proposed system consists of a proposed algorithm for Enhancing Video Quality, Distorting Minimization, Bandwidth efficiency, and Reliability Maximization called (EVQDMBRM) algorithm. The proposed algorithm reduces the video frame's total distortion. In addition, it enhances the video quality in a real-time network by dynamically allocating the flow rate at the video source and maximizing the transmission reliability of the video frames. The result shows that the proposed EVQDMBRM algorithm improves the video quality with the minimized total distortion. Therefore, it improves the Peak Signal to Noise Ratio (PSNR) average by 51.13 dB against 47.28 dB in the existing systems. Furthermore, it reduces the video frames processing time average by 58.2 milliseconds (ms) against 76.1, and the end-to-end delay average by 114.57 ms against 133.58 ms comparing to the traditional methods. The proposed system concentrates on minimizing video distortion and improving the surgical video transmission quality by using an EVQDMBRM algorithm. It provides the mechanism to allocate the video rate at the source dynamically. Besides that, it minimizes the packet loss ratio and probing status, which estimates the available bandwidth.
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Affiliation(s)
- Pooja Maharjan
- School of Computing Mathematics and Engineering, Charles Sturt University (CSU), Sydney, Australia
| | - Abeer Alsadoon
- School of Computing Mathematics and Engineering, Charles Sturt University (CSU), Sydney, Australia
- School of Computer Data and Mathematical Sciences, Western Sydney University (WSU), Sydney, Australia
- Kent Institute Australia, Sydney, Australia
- Asia Pacific International College (APIC), Sydney, Australia
| | - P. W. C. Prasad
- School of Computing Mathematics and Engineering, Charles Sturt University (CSU), Sydney, Australia
- School of Computer Data and Mathematical Sciences, Western Sydney University (WSU), Sydney, Australia
- Kent Institute Australia, Sydney, Australia
- Australian Institute of Higher Education, Sydney, Australia
| | - Ahmad B. Al-Khalil
- College of Science, Department of Computer Science, The University of Duhok, Duhok, KRG Iraq
| | - Oday D. Jerew
- Asia Pacific International College (APIC), Sydney, Australia
| | - Ghossoon Alsadoon
- Business Informatics Department, AMA International University Bahrain (AMAIUB), Salmabad, Bahrain
| | - Binod Chapagain
- School of Computing Mathematics and Engineering, Charles Sturt University (CSU), Sydney, Australia
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Bunnag K, Tansawet A, Jitaroon K, Junthong S, Ungkhara G, Kulthaveesup A, Wangchalabovorn P. Impact of the COVID-19 pandemic on the otolaryngology residency training program in a university-based hospital in Bangkok, Thailand. SAGE Open Med 2022; 10:20503121221141260. [DOI: 10.1177/20503121221141260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
Objective: This study aimed to evaluate the impact of the COVID-19 pandemic on the otolaryngology residency training program in Vajira Hospital, Navamindradhiraj University. Methods: Conducted from October 2021 to January 2022, this cross-sectional survey included all residents, residents who graduated in 2021, and the attending staff. One form was sent to both resident groups for self-assessment and another form to the attending staff for resident assessment. The survey questions were about attitude toward COVID-19 service, knowledge, outpatient department service, surgical skills, and burnout assessment using the Maslach Burnout Inventory. Results: This study included 17 residents and 9 attending staff members. COVID-19 indeed had affected the clinical and surgical training. Regarding the attitude toward COVID-19 services, the residents were moderately satisfied. They were concerned about work suspension resulting from infection and also death from COVID-19. N95 masks and other protective gears were scarce. Compared with those during the prepandemic era, residents had fewer academic activities, and they preferred hybrid teaching. The inpatient department, outpatient department, and surgical training opportunities, as well as elective and urgent surgeries, were also reduced. The attending staff considered 1-year extension of the training program, but the residents disapproved. The residents became less confident both in outpatient department service and surgical skill, and they felt emotional exhaustion, depersonalization, and decreased sense of personal accomplishment. Conclusion: COVID-19 pandemic had significant impact on otolaryngology residency training programs. It did not only affect burnout among residents but also caused a perception of skill and knowledge reduction.
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Affiliation(s)
- Kanokrat Bunnag
- Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Amarit Tansawet
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kawinyarat Jitaroon
- Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sirinan Junthong
- Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Girapong Ungkhara
- Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Anan Kulthaveesup
- Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Online residency training during the COVID-19 pandemic: a national survey of otolaryngology head and neck surgery program directors. J Otolaryngol Head Neck Surg 2021; 50:65. [PMID: 34784978 PMCID: PMC8593638 DOI: 10.1186/s40463-021-00546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has deeply impacted healthcare and education systems, including resident education. The impact of the pandemic on the different types of pedagogical activities, and the displacement of pedagogical activities to online modalities have not yet been quantified. We sought to evaluate the impact of the COVID-19 pandemic on formal pedagogic components of otorhinolaryngology-head and neck surgery (ORL-HNS) residency, the switch to distance learning and program director's perceptions of the future of teaching and learning. METHODS A nationwide online survey was conducted on Canadian ORL-HNS program directors. The use of standard didactic activities in-person and online, before and during the pandemic was rated with Likert scales. Perceptions of the pandemic were described with open-ended questions. RESULTS A total of 11 of the 13 program directors contacted responded. The analysis were conducted using nonparametric statistics. There was a significant drop in overall didactic activities during the pandemic, regardless of the teaching format (3.5 ± 0.2 to 3.1 ± 0.3, p < 0.05). The most affected activities were simulation and in-house lectures. Online activities increased dramatically (0.5 ± 0.2 to 5.0 ± 0.5, p < 0.001), including attendance to lectures made by other programs (0.5 ± 0.3 to 4.0 ± 0.8, p < 0.05). Respondents stated their intention to maintain the hybrid online and in-person teaching model. CONCLUSIONS These findings suggest that hybrid online and in-person teaching is likely to persist in the post-pandemic setting. A balanced residency curriculum requires diversity in academic activities. The pandemic can have positive consequences if higher education institutions work to better support distance teaching and learning.
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Salehi O, Kazakova V, Vega EA, Kutlu OC, Alarcon SV, Freeman R, Kozyreva O, Conrad C. Selection criteria for minimally invasive resection of intrahepatic cholangiocarcinoma-a word of caution: a propensity score matched analysis using the national cancer database. Surg Endosc 2021; 36:5382-5391. [PMID: 34750709 DOI: 10.1007/s00464-021-08842-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND While minimally invasive liver resection (MILR) vs. open approach (OLR) has been shown to be safe, the perioperative and oncologic safety for intrahepatic cholangiocarcinoma (ICC) specifically, necessitating often complex hepatectomy and extended lymphadenectomy, remains ill-defined. METHODS The National Cancer Database was queried for patients with ICC undergoing liver resection from 2010 to 2016. After 1:1 Propensity Score Matching (PSM), Kruskal-Wallis and χ2 tests were applied to compare short-term outcomes. Kaplan-Meier survival analyses and Cox multivariable regression were performed. RESULTS 988 patients met inclusion criteria: 140 (14.2%) MILR and 848 (85.8%) OLR resulting in 115 patients MILR and OLR after 1:1 PSM with c-index of 0.733. MILR had lower unplanned 30-day readmission [OR 0.075, P = 0.014] and positive margin rates [OR 0.361, P = 0.011] and shorter hospital length of stay (LOS) [OR 0.941, P = 0.026], but worse lymph node yield [1.52 vs 2.07, P = 0.001]. No difference was found for 30/90-day mortality. Moreover, multivariate analysis revealed that MILR was associated with poorer overall survival compared to OLR [HR 2.454, P = 0.001]. Subgroup analysis revealed that survival differences from approach were dependent on major hepatectomy, tumor size > 4 cm, or negative margins. CONCLUSION MILR vs. OLR is associated with worse lymphadenectomy and survival in patients with ICC greater than 4 cm requiring major hepatectomy. Hence, MILR major hepatectomy for ICC should only be approached selectively and if surgeons are able to perform an appropriate lymphadenectomy.
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Affiliation(s)
- Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Vera Kazakova
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Onur C Kutlu
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Sylvia V Alarcon
- Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.,Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Olga Kozyreva
- Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.,Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA. .,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.
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11
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Laloo R, Santhosh Karri R, Wanigasooriya K, Beedham W, Darr A, Layton GR, Logan P, Tan Y, Mittapalli D, Patel T, Mishra VD, Odeh OF, Prakash S, Elnoamany S, Peddinti SR, Daketsey EA, Gadgil S, Bouhuwaish A, Ozair A, Bansal S, Elhadi M, Godbole AA, Axiaq A, Rauf FA, Ashpak A. The perceived global impact of the COVID-19 pandemic on doctors' medical and surgical training: An international survey. Int J Clin Pract 2021; 75:e14314. [PMID: 33932265 PMCID: PMC8237016 DOI: 10.1111/ijcp.14314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has resulted in a significant burden on healthcare systems causing disruption to the medical and surgical training of doctors globally. AIMS AND OBJECTIVES This is the first international survey assessing the perceived impact of the COVID-19 pandemic on the training of doctors of all grades and specialties. METHODS An online global survey was disseminated using Survey Monkey® between 4th August 2020 and 17th November 2020. A global network of collaborators facilitated participant recruitment. Data were collated anonymously with informed consent and analysed using univariate and adjusted multivariable analyses. RESULTS Seven hundred and forty-three doctors of median age 27 (IQR: 25-30) were included with the majority (56.8%, n = 422) being male. Two-thirds of doctors were in a training post (66.5%, n = 494), 52.9% (n = 393) in a surgical specialty and 53.0% (n = 394) in low- and middle-income countries. Sixty-nine point two percent (n = 514) reported an overall perceived negative impact of the COVID-19 pandemic on their training. A significant decline was noted amongst non-virtual teaching methods such as face-to-face lectures, tutorials, ward-based teaching, theatre sessions, conferences, simulation sessions and morbidity and mortality meetings (P ≤ .05). Low or middle-income country doctors' training was associated with perceived inadequate supervision while performing invasive procedures under general, local or regional anaesthetic. (P ≤ .05). CONCLUSION In addition to the detrimental impact of the COVID-19 pandemic on healthcare infrastructure, this international survey reports a widespread perceived overall negative impact on medical and surgical doctors' training globally. Ongoing adaptation and innovation will be required to enhance the approach to doctors' training and learning in order to ultimately improve patient care.
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Affiliation(s)
- Ryan Laloo
- The Master Surgeon TrustWorcestershireUK
- Leeds Vascular Institute, Leeds General InfirmaryLeedsUK
| | - Rama Santhosh Karri
- The Master Surgeon TrustWorcestershireUK
- The Royal Wolverhampton NHS TrustWolverhamptonUK
| | - Kasun Wanigasooriya
- The Master Surgeon TrustWorcestershireUK
- College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - William Beedham
- The Master Surgeon TrustWorcestershireUK
- College of Medical and Dental ScienceUniversity of BirminghamBirminghamUK
| | - Adnan Darr
- The Master Surgeon TrustWorcestershireUK
- The Royal Wolverhampton NHS TrustWolverhamptonUK
| | - Georgia R Layton
- The Master Surgeon TrustWorcestershireUK
- Department of Cardiac SurgeryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Peter Logan
- The Master Surgeon TrustWorcestershireUK
- Walsall Healthcare NHS TrustWalsallUK
| | - Yanyu Tan
- The Master Surgeon TrustWorcestershireUK
- North East DeaneryNewcastleUK
| | - Devender Mittapalli
- The Master Surgeon TrustWorcestershireUK
- University Hospitals Plymouth NHS TrustPlymouthUK
| | | | | | | | | | | | | | | | | | | | - Ahmad Ozair
- Faculty of MedicineKing George's Medical UniversityLucknowUttar PradeshIndia
| | - Sanchit Bansal
- Vardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
| | | | - Aditya Amit Godbole
- Bharati Vidyapeeth (Deemed to be University) Medical CollegeDhankawadi, PuneIndia
| | - Ariana Axiaq
- School of MedicineFaculty of Life SciencesQueen's University BelfastBelfastUK
| | | | - Ashna Ashpak
- School of MedicineUniversity of Central LancashirePrestonLancashireUK
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12
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O'Rielly C, Ng-Kamstra J, Kania-Richmond A, Dort J, White J, Robert J, Brindle M, Sauro K. Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services. BMJ Open 2021; 11:e043966. [PMID: 34130956 PMCID: PMC8210688 DOI: 10.1136/bmjopen-2020-043966] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To understand how surgical services have been reorganised during and following public health emergencies, particularly the first wave of the COVID-19 pandemic, and the consequences for patients, healthcare providers and healthcare systems. DESIGN A rapid scoping review. SETTING We searched the MEDLINE, Embase and grey literature sources for documents and press releases from governments and surgical organisations or associations. PARTICIPANTS Studies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems were included. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were strategies implemented for the reorganisation of surgical services. Secondary were the impacts of reorganisation and resuming surgical services, such as: adverse events (including morbidity and mortality), primary care and emergency department visits, length of hospital and ICU stay, and changes to surgical waitlists. RESULTS One hundred and thirty-two studies were included in this review; 111 described reorganisation of surgical services, 55 described the consequences of reorganising surgical services; and 6 reported actions taken to rebuild surgical capacity in public health emergencies. Reorganisations of surgical services were grouped under six domains: case selection/triage, personal protective equipment (PPE) regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganisations led to large reductions in non-urgent surgical volumes, increases in surgical wait times and impacted medical training (ie, reduced case involvement) and patient outcomes (eg, increases in pain). Strategies for rebuilding surgical capacity were scarce but focused on the availability of staff, PPE and patient readiness for surgery as key factors to consider before resuming services. CONCLUSIONS Reorganisation of surgical services in response to public health emergencies appears to be context dependent and has far-reaching consequences that must be better understood in order to optimise future health system responses to public health emergencies.
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Affiliation(s)
- Connor O'Rielly
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joshua Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Joseph Dort
- University of Calgary, Calgary, Alberta, Canada
| | - Jonathan White
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jill Robert
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Mary Brindle
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Khara Sauro
- Community Health Sciences, Surgery & Oncology, University of Calgary, Calgary, Alberta, Canada
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13
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Seifman MA, Fuzzard SK, To H, Nestel D. COVID-19 impact on junior doctor education and training: a scoping review. Postgrad Med J 2021; 98:466-476. [PMID: 33688067 DOI: 10.1136/postgradmedj-2020-139575] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/06/2021] [Indexed: 11/03/2022]
Abstract
COVID-19 has had a significant impact on healthcare resources and the medical workforce. Clinically-based medical education is the principal source of learning, and this has been profoundly impacted by restrictions due to COVID-19. It follows that junior medical staff and their education would be significantly impacted due to the altered volume and breadth of their clinical exposure. Some literature has been published regarding the impact to medical training during COVID-19. This study sought to review junior medical staff perceptions and their reported impact of the COVID-19 pandemic on their education and training.Nine databases (three Ovid MEDLINE databases, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Centre and PsychINFO) were searched for studies published in 1 January 2020 through 24 August 2020. Via a scoping review protocol, an iterative process was used to perform the identification, review and charting analysis of the reported outcomes and themes. Descriptive analysis was performed using quantitative and qualitative methods.Of the 25 343 sources identified, 32 were included in the review. There were studies published from nearly all continents, predominantly in surgical journals, with a wide spread of specialties. Themes identified included the current impact of the pandemic in relation to continuation of and modifications to training programmes, as well as the future impact due to training requirements and career progression.Junior medical staff report that the COVID-19 pandemic has had a significant impact on their education and training. Whether the changes imposed by the pandemic on education are temporary measures or permanent fixtures, and whether standards of competence may be impacted, is not yet known. This scoping review forms a basis for further investigation in the field.
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Affiliation(s)
- Marc Adam Seifman
- Plastic, Reconstructive and Hand Surgery Unit, Peninsula Health, Frankston, Victoria, Australia .,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sibon K Fuzzard
- Plastic, Reconstructive and Hand Surgery Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Henry To
- Northern Health Research and Education, Epping, Victoria, Australia
| | - Debra Nestel
- Surgery-Austin Health Precinct, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
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14
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Yang SF, Powell A, Srinivasan S, Kim JC, Baker SR, Green GE, Zopf DA. Addressing the Pandemic Training Deficiency: Filling the Void with Simulation in Facial Reconstruction. Laryngoscope 2021; 131:E2444-E2448. [PMID: 33656188 PMCID: PMC8013962 DOI: 10.1002/lary.29490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/21/2021] [Accepted: 02/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS To assess the use of a three-dimensional (3D) printed, multilayer facial flap model for use in trainee education as an alternative method of teaching surgical techniques of facial reconstruction. STUDY DESIGN Cohort study. METHODS A 3D printed facial flap simulator was designed from a computed tomography scan and manufactured out of silicone for low-cost, high-fidelity simulation. This simulator was tested by a group of Otolaryngology-Head and Neck Surgery trainees at a single institution. The simulator group was compared to a control group who completed an exercise on a traditional paper facial flap exercise. Both groups underwent didactic lectures prior to completing their respective exercises. Pre- and post-exercise Likert scale surveys measuring experience, understanding, effectiveness, and realism were completed by both groups. Central tendency, variability, and confidence intervals were measured to evaluate the outcomes. RESULTS Trainees completing the facial flap simulator reported a statistically significant (p < 0.05) improvement in overall expertise in facial flap procedures, design of facial flaps, and excision of standing cutaneous deformities. No statistically significant improvement was seen in the control group. CONCLUSIONS Trainees found the facial flap simulator to be an effective and useful training tool with a high level of realism in surgical education of facial reconstruction. Surgical simulators can serve as an adjunct to trainee education, especially during extraordinary times such as the novel coronavirus disease 2019 pandemic, which significantly impacted surgical training. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2444-E2448, 2021.
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Affiliation(s)
- Shiayin F Yang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Allison Powell
- University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | | | - Jennifer C Kim
- Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Shan R Baker
- Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Glenn E Green
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - David A Zopf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, Michigan, U.S.A.,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
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15
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Aziz H, James T, Remulla D, Sher L, Genyk Y, Sullivan ME, Sheikh MR. Effect of COVID-19 on Surgical Training Across the United States: A National Survey of General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2021; 78:431-439. [PMID: 32798154 PMCID: PMC7391955 DOI: 10.1016/j.jsurg.2020.07.037] [Citation(s) in RCA: 143] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/13/2020] [Accepted: 07/25/2020] [Indexed: 05/11/2023]
Abstract
INTRODUCTION COVID-19 emerged as a global pandemic in 2020 and has affected millions of lives. Surgical training has also been significantly affected by this pandemic, but the exact effect remains unknown. We sought to perform a national survey of general surgery residents in the United States to assess the effect of COVID-19 on surgical resident training, education, and burnout. METHODS An anonymous online survey was created and distributed to general surgery residents across the United States. The survey aimed to assess changes to surgical residents' clinical schedules, operative volume, and educational curricula as a result of the COVID-19 pandemic. Additionally, we sought to assess the impact of COVID-19 on resident burnout. RESULTS One thousand one hundred and two general surgery residents completed the survey. Residents reported a significant decline in the number of cases performed during the pandemic. Educational curricula were largely shifted toward online didactics. The majority of residents reported spending more time on educational didactics than before the pandemic. The majority of residents feared contracting COVID-19 or transmitting it to their family during the pandemic. CONCLUSIONS COVID-19 has had significant impact on surgical training and education. One positive consequence of the pandemic is increased educational didactics. Online didactics should continue to be a part of surgical education in the post-COVID-19 era. Steps need to be taken to ensure that graduating surgical residents are adequately prepared for fellowship and independent practice despite the significantly decreased case volumes during this pandemic. Surgery training programs should focus on providing nontechnical clinical training and professional development during this time.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Tayler James
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Daphne Remulla
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Linda Sher
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yuri Genyk
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Maura E Sullivan
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mohd Raashid Sheikh
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
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16
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Abstract
Background Coronavirus disease (COVID-19) has caused global disruption to health care. Non-urgent elective surgical cases have been cancelled, outpatient clinics have reduced and there has been a reduction in the number of patients presenting as an emergency. These factors will drastically affect the training opportunities of surgical trainees. The aim of this systematic review is to describe the impact of COVID-19 on surgical training globally. Methods The review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched. Results The searches identified 499 articles, 29 of which were included in the review. This contained data from more than 20 countries with 5260 trainees and 339 programme directors. Redeployment to non-surgical roles varied across studies from 6% to 35.1%. According to all of the studies, operative experience has been reduced. Knowledge learning had been switched to online platforms across 17 of the studies and 7 reported trainees had increased time to devote to educational/academic activities. All of the studies reporting on mental health report negative associations with increased stress, ranging from 54.9% to 91.6% of trainees. Conclusions The impact of COVID-19 on surgical trainees has been experienced globally and across all specialities. Negative effects are not limited to operative and clinical experience, but also the mental health and wellbeing of trainees. Delivery of surgical training will need to move away from traditional models of learning to ensure trainees are competent and well supported. Supplementary Information The online version contains supplementary material available at 10.1007/s10151-020-02404-5.
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17
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Luu NN, Yver CM, Douglas JE, Tasche KK, Thakkar PG, Rajasekaran K. Assessment of YouTube as an Educational Tool in Teaching Key Indicator Cases in Otolaryngology During the COVID-19 Pandemic and Beyond: Neck Dissection. JOURNAL OF SURGICAL EDUCATION 2021; 78:214-231. [PMID: 32646815 PMCID: PMC7338020 DOI: 10.1016/j.jsurg.2020.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES YouTube has become the preferred resource for trainees in otolaryngology to prepare for surgery. This study aimed to compare the evaluation by 2 attending physicians and 2 resident physicians of the quality of videos on YouTube on neck dissection, a key indicator case in head and neck surgery. The authors aimed to assess the quality and quantity of YouTube videos available for development of a virtual surgical educational curriculum for trainees in otolaryngology. METHODS Using the YouTube search feature, the top 10 videos by relevance and view count were compiled using the following search terms: radical neck dissection, selective neck dissection, modified radical neck dissection, lateral neck dissection, levels I-III neck dissection, levels II-IV, left neck dissection, right neck dissection, cervical nodal dissection, and supraomohyoid neck dissection. A total of 37 videos on neck dissection were identified and analyzed using the LAP-VEGaS criteria as well as author-specific modified LAP-VEGaS criteria. RESULTS The mean comprehensive LAP-VEGaS score was 8.74 (SD 3.10). The majority of videos (24/37) were designated as medium quality; 10 of 37 videos were low quality and 3 of 37 videos were high quality. In the total group analysis, there was excellent inter-rater reliability between attending physicians (Cohen's kappa coefficient of 0.84) and good inter-rater reliability between resident physicians (Cohen's kappa coefficient of 0.58). There was no correlation between total view count, video age, or number of likes/dislikes and the overall LAP-VEGaS score. The presence of audio or written commentary had a moderate positive correlation with LAP-VEGaS score (adjusted R2 of 0.36). There was no statistically significant difference in video quality between videos posted by US and non-US based physicians (95% confidence interval -0.10 to 4.10; p = 0.06). However, videos made by an otolaryngology-trained physician had a LAP-VEGaS score that was 3.93 points higher (95% confidence interval 2.34-5.52; p < 0.001) than that of videos made by a nonotolaryngology-trained physician. CONCLUSIONS Online videos of neck dissection represent an increasingly ubiquitous and appropriate resource for trainees in learning otolaryngology key indicator cases. While free-to-access video repositories, such as YouTube, have become increasingly popular among trainees as a primary resource for learning and preparing for surgical cases, they lack consistent quality and as such, global efforts should be taken to improve the breadth and depth of educational video content in otolaryngology.
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Affiliation(s)
- Neil N Luu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Christina M Yver
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer E Douglas
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kendall K Tasche
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Punam G Thakkar
- Department of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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18
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Kahwash BM, Deshpande DR, Guo C, Panganiban CM, Wangberg H, Craig TJ. Allergy/Immunology Trainee Experiences During the COVID-19 Pandemic: AAAAI Work Group Report of the Fellows-in-Training Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1-6.e1. [PMID: 33144147 PMCID: PMC7605747 DOI: 10.1016/j.jaip.2020.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 11/01/2022]
Abstract
As a result of the coronavirus disease 2019 (COVID-19) global pandemic, medical trainees have faced unique challenges and uncertainties. To capture the experiences of allergy and immunology fellows throughout the United States and Canada during this time, a 17-item electronic questionnaire was distributed to 380 fellow-in-training (FIT) members of the American Academy of Allergy, Asthma, and Immunology enrolled in US and Canadian allergy/immunology fellowship programs. Voluntary and anonymous responses were collected from April 15 to May 15, 2020. In addition to summary statistics, categorical data were compared using χ2 tests (Fisher's exact). Responses were obtained from FITs across all years of training and primary specialties (Internal Medicine, Pediatrics, and Medicine-Pediatrics) with a response rate of 32.6% (124 of 380). Reassignment to COVID-19 clinical responsibilities was reported by 12% (15 of 124) of FITs, with the largest proportion in the US northeast region. A majority of FITs used telehealth (95%) and virtual learning (82%) during the pandemic. Overall, 21% (25 of 120) of FITs expressed concern about potentially lacking clinical experience for independently practicing allergy and immunology. However, FITs using telehealth reported lower concern compared with those who did not (18.4% [21 of 114] vs 66.7% [4 of 6]; P = .01). The survey shows that allergy and immunology trainee experiences have varied considerably since the COVID-19 outbreak. Notably, the adoption of telehealth and virtual learning was commonly reported, and optimization of these virtual experiences will be helpful. Even outside of pandemics, training on the use of telemedicine may be a sound strategy in preparation for future health care delivery and unexpected events.
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Affiliation(s)
- Basil M Kahwash
- Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University College of Medicine, Columbus, Ohio; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Deepti R Deshpande
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY.
| | - Canting Guo
- Department of Allergy and Immunology, Springfield Clinic, Springfield, Ill
| | - Christine M Panganiban
- Division of Basic and Clinical Immunology, Department of Medicine, University of California, Irvine, Orange, Calif
| | - Hannah Wangberg
- Division of Allergy, Asthma, and Immunology, Scripps Health, San Diego, Calif
| | - Timothy J Craig
- Department of Medicine, Pediatrics and Biomedical Sciences, Penn State University, Hershey, Pa
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19
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Guo T, Kiong KL, Yao CMKL, Windon M, Zebda D, Jozaghi Y, Zhao X, Hessel AC, Hanna EY. Impact of the COVID-19 pandemic on Otolaryngology trainee education. Head Neck 2020; 42:2782-2790. [PMID: 32666664 PMCID: PMC7405272 DOI: 10.1002/hed.26368] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has reduced clinical volume with a negative impact on trainee education. METHODS Survey study of Otolaryngology trainees in North America, during the COVID-19 pandemic in April 2020. RESULTS Of 216 respondents who accessed the survey, 175 (83%) completed the survey. Respondents reported a universal decrease in clinical activities (98.3%). Among participants who felt their program utilized technology well, there were significantly decreased concerns to receiving adequate educational knowledge (29.6% vs 65.2%, P = .003). However, 68% of trainees still expressed concern in ability to receive adequate surgical training. In addition, 54.7% of senior trainees felt that the pandemic had a negative impact on their ability to secure a job or fellowship after training. CONCLUSIONS Trainees universally felt a negative impact due to the COVID-19 pandemic. Use of technology was able to alleviate some concerns in gaining adequate educational knowledge, but decreased surgical training remained the most prevalent concern.
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Affiliation(s)
- Theresa Guo
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kimberley L. Kiong
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Christopher M. K. L. Yao
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Melina Windon
- Department of Otolaryngology‐Head & Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Denna Zebda
- Department of Otorhinolaryngology‐Head & Neck Surgery, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Yelda Jozaghi
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Xiao Zhao
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Amy C. Hessel
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ehab Y. Hanna
- Department of Head & Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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20
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Bandi F, Karligkiotis A, Mellia J, Gallo S, Turri-Zanoni M, Battaglia P, Castelnuovo P. Strategies to overcome limitations in Otolaryngology residency training during the COVID-19 pandemic. Eur Arch Otorhinolaryngol 2020; 277:3503-3506. [PMID: 32705361 PMCID: PMC7377304 DOI: 10.1007/s00405-020-06228-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The COVID-19 pandemic has produced an unequaled human crisis forcing a radical reorganization in the healthcare system. Otolaryngologists are at high risk of exposure, and changes in medical and surgical activities have reduced the learning opportunity for residents and fellows. We believe that even during COVID-19 crisis it is mandatory to guarantee an optimal training, and here, we propose some strategies, based on our experience, to further increase our trainees' learning curve. METHODS We asked our trainees to fill out an electronic survey about several aspect of their training: a first section focused on the reduction of clinical activities and the perceived impact of the pandemic on residents' skills; the second part outlined the type of attended training activity and the perceived benefit. RESULTS Surgical training has been reported by our residents as the activity perceived to be the most contracted during the pandemic. According to residents' opinion the most useful activities were dissection (n = 8, 53.4% residents) and online journal clubs/webinars (n = 7, 46.6% of residents). Residents' suggestions included actively participating to tracheostomy procedures on SARS-CoV-2 positive patients, attending lessons held by senior consultants on basic ENT topics and promoting collegial discussion of inpatient clinical cases. CONCLUSION Building on this dramatic experience, we must be ready for a global restructuring of the residency program to provide an adequate trainee education for the future surgeons.
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Affiliation(s)
- Francesco Bandi
- Department of Otolaryngology-Head and Neck Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Jessica Mellia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Stefania Gallo
- Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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