key: cord-0734290-tnl3d0wn authors: Goyal, Nishant; Chaturvedi, Jitender; Chandra, P. Prarthana; Raheja, Amol title: Letter to the Editor Regarding “Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large United States Academic Medical Center” date: 2020-11-14 journal: World Neurosurg DOI: 10.1016/j.wneu.2020.10.085 sha: c05870f2c8aa2108b4c8537346d343cadbf6dd5e doc_id: 734290 cord_uid: tnl3d0wn nan Letter to the Editor Regarding "Early Changes to Neurosurgery Resident Training During the COVID- 19 Pandemic at a Large United States Academic Medical Center" Q1 LETTER: W e read with great interest the article entitled "Early Changes to Neurosurgery Resident Training During the COVID- 19 Pandemic at a Large United States Academic Medical Center." 1 In this article, Burks et al. 1 described the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on neurosurgery resident training. The authors analyzed the resident and institutional case totals for their residency program in Miami-Dade County, Florida, USA, from January 1, 2019, to June 30, 2020. They observed significantly lower cases logged in by the residents during the months of April and May in 2020 compared with 2019. This corroborated with the reductions in the surgical volume of the department during the COVID-19 pandemic in Miami in April and May 2020. While all specialties decreased during the ongoing COVID-19 pandemic, the maximum decline was observed concerning cases of thoracic/lumbar laminectomy with or without instrumentation, functional/epilepsy, and neuroendovascular cases. Burks et al. 1 stated that theirs is the first report on relative changes in surgical numbers during the ongoing pandemic by case type. We would like to bring to their attention our experience from the All India Institute Medical Sciences, Rishikesh, India, where we described the change in volume and spectrum of cases during the ongoing COVID-19 pandemic during the lockdown period in the country (March 25 to May 31, 2020) and compared it with that from the same period of time in 2019. 2 During the lockdown period in 2020, we performed 53 surgeries (47 emergency, 6 routine) compared with 111 surgeries (47 emergency, 64 routine) during the same time period in 2019, indicating an overall decline of 52.2%. 2, 3 Furthermore, as the number of COVID-19 cases rose in the state, the number of surgeries performed per week declined steadily (Rs 8 ¼ À0.914, P ¼ 0.000). On comparing our operative workload per specialty with the preeCOVID-19 era, a decrease in number of cases was noted across all specialties. We observed that the number of neurooncology cases decreased from 36 (30 cranial, 6 spinal) in the preeCOVID-19 era to 14 (12 cranial, 2 spinal) during the COVID-19 period. Of these, only 1 case was done by the transsphenoid route during the COVID-19 period compared with 3 cases in the pree COVID-19 era. Neurotrauma cases also decreased from 27 (21 head injuries, 6 spinal injuries) in this time period in 2019 to 15 (12 head injuries, 3 spinal injuries) during the pandemic. There were 2 cases of surgical clipping of intracranial aneurysms during the COVID-19 lockdown compared with 5 cases during the same time period last year. No patients underwent surgery for congenital conditions or degenerative spinal disorders during the lockdown period, whereas 7 congenital conditions and 9 degenerative spinal disorders were surgically treated during the same time period in 2019. The number of cerebrospinal fluid diversion procedures was least affected during the pandemic (18 in the time period in 2019 vs. 16 during COVID-19). 2, 4, 5 Neurosurgical centers from across the world have been forced to restrict their operative and outpatient volumes and change from physical outpatient encounters to telemedicine, which is likely to have an adverse impact on resident training. [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] Decrease in operative volumes has reduced surgical opportunities for residents. Regarding resident training, we have observed findings very similar to Burks et al. 1 at our center as well as all over India. At our center, we have taken various measures to prevent infections in the residents by restricting physical outpatient encounters, canceling elective cases during the peak of the pandemic, working with reduced staffing, and providing all health care workers with adequate personal protective equipment. 26 With these changes, we have been able to maintain our emergency neurosurgery services and have not had a single case of COVID-19 in any of our residents. 27 Similar measures were taken at the institution of Burks et al., 1 but they have reported that 2 residents in their program were infected with COVID-19, as Miami was badly impacted at the time their study was conducted. Burks et al. 1 expressed concern about the effect of the pandemic on residents' surgical training. They reported that their residents logged in an average of 15 (58%) and 5 (20%) fewer cases in April 2020 and May 2020, respectively, and this result was statistically significant. In a nationwide survey conducted among 118 neurosurgery residents from India from May 7, 2020, to May 16, 2020, 28 we observed a significant decline of 67.5% in the surgical exposure of residents since the onset of the pandemic, with the average number of surgeries performed by a resident decreasing from 39.9 to 12.3 per month (P ¼ 0.000). In addition, three fourths of respondents reported hampering of research activities, and the number of academic sessions had decreased by 32.6% from a median of 5 per week to 2 per week (P ¼ 0.000). 5, 29 Departments of >60% of our respondents had transitioned from physical classroom teaching to video conferencing platforms to conduct academic sessions. During the pandemic, most neurosurgery residents resorted to self-study (83.89%), scientific writing (43.22%), and attending online educational programs (73.72%) in the extra time available. Other authors from across the world have voiced their concerns regarding neurosurgery training during the COVID-19 pandemic. [30] [31] [32] [33] [34] Zoia et al. 30 from Italy reported that surgical exposure during the pandemic decreased for 78.6% of residents, while 16.1% did not operate at all. Burks et al. 1 suggested increasing the number of residents scrubbing in each case to at least partially make up for the loss in surgical exposure. Training is a time for neurosurgery residents to learn as much as they can from their patients, colleagues, attending consultants, and staff in terms of learning clinical and operative skills as well as focusing on research and academics. These years of intensive training are "make or break" time in the life of every neurosurgeon. No stone must be left unturned to ensure that the training of neurosurgery residents does not suffer during the ongoing pandemic. Various neurosurgery societies have taken on the responsibility and are conducting online educational programs to ensure continued neurosurgery training. [35] [36] [37] CRediT AUTHORSHIP CONTRIBUTION STATEMENT Nishant Goyal: Conception and design of the study; Writingoriginal draft; Visualization; Writing-review and editing. Jitender Chaturvedi: Data curation. P. Prarthana Chandra: Writingoriginal draft; Visualization. Amol Raheja: Writing-review and editing. LETTER TO THE EDITOR 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 LETTER TO THE EDITOR 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 Early changes to neurosurgery resident training during the COVID-19 pandemic at a large United States academic medical center World Neurosurg Collateral damage caused by COVID-19: change in volume and spectrum of neurosurgery patients COVID-19 impact on neurosurgical practice: lockdown attitude and experience of a European academic center Neurosurgical referral patterns during the COVID-19 pandemic: a United Kingdom experience Impact of COVID-19 on an academic neurosurgery department: the Johns Hopkins experience An Australian response to the COVID-19 pandemic and its implications on the practice of neurosurgery Neurosurgical procedures and safety during the COVID-19 pandemic: a case-control multicenter study. 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