key: cord-285639-1vf7ot1r
authors: Tait, S.; McLean, R.; Gopinath, B.
title: COVID 19 and training in the UK- Correspondence
date: 2020-05-01
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.04.061
sha: 
doc_id: 285639
cord_uid: 1vf7ot1r

nan

The COVID 19 pandemic has caused major disruption to training in all aspects of medicine and surgery. Trainees from all specialities have felt the impact; with Medical Students being expedited onto foundation programmes [1] . Unfortunately, with the current crisis, performing surgical procedures poses a major risk to our own health and the health of our patients. The current priority for us is to maintain an effective surgical workforce and effectively cover emergency surgery [2] . As such, most elective operating has been suspended since March 2020. This, alongside the potential for trainees being redeployed to support their critical care, medical and emergency medicine colleagues, has severely reduced the access trainees have to training opportunities. Whilst we are eager to assist our colleagues in such an unprecedented situation it cannot be ignored this will have an impact on our training.

Currently trainees are still expected to achieve their ARCP outcomes which includes operative numbers for core and registrar level trainees. Operation numbers have been an integral part of achieving surgical competency [3] as an indication for their surgical experience. In our district General we have 10 trainees (CT1-ST8). On reviewing operative numbers, there was a reduction of operative numbers to 20% of normal, amongst trainees comparing the month before and after lockdown came into effect in late March. Furthermore, looking at both elective and emergency operating, there has been a decline in numbers since January. In our trust in January 2020, 294 general surgical elective operations were performed. This dropped to 109 in March and in the month since lockdown (23/03/2020), has decreased further to 26. Over the same period in emergency surgery; in January 2020 97 operations were performed, in March 2020 75 and since lockdown 27. It is likely the case in all trusts across the UK and the steady decline since January will have a knock on effect come July ARCP. This is a difficult time for surgical training both now and in the near future. Current fears surround the impact on ARCP outcomes for trainees with the potential for training to be extended so that competencies can be met. At present, the Royal colleges and the four statutory education bodies [4] and the 15 Speciality Associations have released a statement in regards to training and indicative operative numbers; the current situation will take into account in regards to progression, but what that means in real terms is still unclear at present. What form this impact will take will be revealed fully over the next few months.

A few other factors will also have a great impact on training outcomes; exams have been delayed [5] with implications for progression for future ST3 applications and those looking to attain Certificate of Completion of Training (CCT). Mandatory courses are now postponed with implications not only for those whose courses have been cancelled but a knock on effect to those who require access to these mandatory courses in the next couple of years as the back log is cleared. The ST3 application for surgical training has changed vastly from a face to face approach to a self-assessment form [4] ; generating concerns that this approach may not be reflective of a trainee's true aptitude and competence and applying further pressure to a normally stressful time; application to higher level (ST3 training). This is an anxious time being a national emergency and trainees are already struggling with fears about their own personal safety and that of their families. With the confounding factors of meeting ARCP requirements, changes to ST3 surgical application process, delays in exams and courses and the knock-on effect on progression, this is a difficult and dark time for surgical training. The long-term effects of which we are likely going to be feeling for the next few years.

With these anxieties in mind, the Joint Committee on Surgical Training (JCST) [4] has arranged access to psychological support for trainees in this difficult and uncertain time. They are also reviewing the impact on surgical training and the ARCP process. In the near future the shape of training during this pandemic should hopefully be clearer.

No ethical approval required.

None.

S. Tait: Visualisation, Investigation, Original Draft preparation. R McLean: Conceptualisation, supervision. B Gopinath: Supervision, Writing-reviewing and editing.

1. Name of the registry: Not Applicable 2. Unique Identifying number or registration ID: Not Applicable 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not Applicable

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Gopinath University Hospital of North Tees