key: cord-331844-trjxt9qk
authors: de Berker, Henry T; Bressington, Morgan J; Mayo, Isaac M; Rose, Anna; Honeyman, Calum
title: Surgical training during the COVID-19 pandemic: challenges and opportunities for junior trainees
date: 2020-08-13
journal: Journal of Plastic, Reconstructive & Aesthetic Surgery
DOI: 10.1016/j.bjps.2020.08.014
sha: 
doc_id: 331844
cord_uid: trjxt9qk

Summary In this piece of correspondence, the authors set out the challenges and opportunities presented by the SARS-CoV-2 (COVID-19) pandemic to junior surgical trainees embarking on a career in plastic surgery.

The SARS-CoV-2 (COVID-19) pandemic has resulted in an unprecedented disruption of surgical services and training around the world. 1 However, faced with significant pressure and evolving challenges, many surgeons have united in an impressive, proactive response leading to the rapid reorganisation of services and significant innovation. 2 Junior doctors embarking on surgical training in August face uncertainty, a markedly different training landscape, and justifiable concerns about their ongoing professional development. Current core surgical trainees have lost almost four months of training time due to redeployment and may feel poorly equipped to transition into their chosen specialties next year. However, this article highlights the many excellent training opportunities that still exist that should adequately bridge the gap until a more recognisable model of training resumes.

Core surgical trainees starting in August, and those returning to their posts after redeployment, face new rota patterns and the ever-present concern of a 'second wave' causing further disruption to training. Furthermore, there is restricted access to theatre due to PPE shortages, consultant-driven operating, and staffing limitations imposed on general anaesthetic lists. Undoubtedly, the current climate is putting significant pressure on a cohort that has already been under considerable strain in recent months. In addition to changes in working practises, trainees have seen exams, conferences, courses and teaching programmes cancelled across the United Kingdom.

Furthermore, disruption to laboratories and clinical trials may limit progress for trainees looking to pursue an integrated academic pathway in the future.

However, although the surgical training landscape has changed, seemingly overnight, many excellent training opportunities exist that will be invaluable to any surgical trainee interested in a career in Plastic Surgery. Also, as trainees reflect on their experiences of redeployment, many will have gained skills that will serve them well in their future careers.

The majority of non-urgent Plastic Surgery elective work has been suspended for the foreseeable future. This includes microsurgical breast reconstruction, which will likely have a detrimental effect on competency attainment for senior trainees approaching completion of training. However, there is still a substantial throughput of burns, trauma and skin cancer operating, all of which form the essential foundation of any successful registrar application. 3 Much of the trauma and skin cancer work is performed under local anaesthetic, often away from main theatres and, as such, fewer restrictions apply. Now, more than ever, trainees must work together to share ward commitments and on-call bleeps in order to maximise opportunities to attend these invaluable lists, and engage with trainers to set specific learning objectives for each case. Trainees and consultants should convene regularly, to continually improve departmental training opportunities. Furthermore, with a greater consultant presence in theatre, there are opportunities for trainees to obtain one-to-one training on index procedures that may not have been possible previously.

In addition to maximising exposure in theatre, there are a number of innovative ways to learn outside of the workplace. Low-cost tendon repair simulation on pigs' trotters, home microsurgery training platforms, and freely available simulation programmes (e.g. Touch Surgery) can all help to develop essential skills in Plastic Surgery. 4 In addition, courses such as the Duke and Penn Flap courses, are being run virtually and free-ofcharge; an opportunity to learn from internationally-renowned trainers without the substantial cost of attending in person. Many departments are moving their teaching online, with a huge expansion of reconstructive webinars released since lockdown began. 5 Although many of these are pitched to higher level trainees, there are also resources that are ideal for core surgical trainees aiming to get to grips with the specialty, including the excellent 'Plastic Surgery Covered' series from the Plastic Surgery Trainees Association (PLASTA). Rapid reorganisation of surgical services has created many new pathways that are ideal for audit, quality improvement and research projects. Conferences have also moved to virtual platforms which will reduce the cost of attending, and thus remove barriers to presenting work and learning from others. Many deaneries now support study leave requests to attend virtual conferences and courses.

Redeployment in itself can also be a time of personal and professional development. The trainee redeployed to the emergency department may gain increased independence in basic wound care and the assessment and management of hand injuries, bites and other minor trauma. In addition, the non-technical skills required to adapt quickly to an unfamiliar environment, remain up-to-date in a rapidly changing clinical crisis, communicate effectively with a new team, and navigate fraught interactions with patients and their relatives will serve any future surgeon well.

Aside from surgical training, trainee morale is justifiably low at present. However, for current and future core surgical trainees, there are numerous possibilities for professional development, training and innovation. Despite considerable challenges, COVID-19 has brought with it an inventive and flexible approach to training; we hope this will continue as attention returns to training safe and confident surgeons of the future.

None

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