key: cord-0908829-exwtnp8y authors: Caruana, Edward J.; Patel, Akshay; Kendall, Simon; Rathinam, Sridhar title: Impact of Covid-19 on training and wellbeing in subspecialty surgery: a national survey of cardiothoracic trainees in the United Kingdom. date: 2020-06-01 journal: J Thorac Cardiovasc Surg DOI: 10.1016/j.jtcvs.2020.05.052 sha: 8250100a24de48eed6cb4c1d7f45873912f5bdeb doc_id: 908829 cord_uid: exwtnp8y Structured Abstract Objectives The Covid-19 pandemic has overwhelmed healthcare systems and disrupted routine care internationally. Healthcare workers face disruption to their work routines and professional development, as well as an elevated risk of infection and morbidity. We sought to establish the impact of the Covid-19 pandemic on the wellbeing, practice and progression of all trainees in cardiothoracic surgery in the United Kingdom. Methods A 31-item questionnaire was designed, validated, and disseminated via email and an instant-messaging platform. Results 76 (of 118, 64%) cardiothoracic surgical trainees responded, representing all training grades and programmes nationally. 48 (63%) and 24 (32%) were concerned about their physical and mental health respectively. 25 (33%) had taken time off work due to Covid-19. 65 (86%) had treated Covid-19 patients, 36 of whom (55%) were wearing satisfactory personal protective equipment at the time. 41 (54%) remain concerned about PPE provision at their institution. 42 (55%) had been redeployed to cover other specialties. 23 (30%) had encountered ethical dilemmas related to care of patients. There was a significant impact on time spent in outpatient clinics (44% reduction), multidisciplinary team meetings (79% reduction) and operating theatres (78% reduction). 67 (88%) of respondents were concerned about the impact on their training, and 54 (71%) felt that the deviation may require an extension in their planned training time. Conclusions The duration and impact of the current pandemic is, as yet, uncertain. Timely sharing of experiences, concerns and expectations will inform healthcare and education policy, and influence practice in the pandemic era and beyond. The Covid-19 pandemic poses significant personal and professional challenges to trainees. 23 Nonetheless, it is a teachable moment -focusing on core values, professionalism, quality 24 and safety of care. professional specialty areas, to provide care to patients with Covid-19. There is, resultantly, 72 widespread disruption of standard care that is likely to last for many months. Healthcare workers are at an increased risk of contracting the virus, and a high rate of 74 morbidity has been noted in countries with a high burden of disease 2-4 . Trainees form a 75 significant proportion of the medical workforce that has been redeployed to reinforce care 76 provision at the Covid-19 frontline, raising concern that their physical health and mental 77 wellbeing may be at risk 3 . This reallocation away from their parent specialty poses numerous challenges, not the least 79 of which being trainees' level of competence and confidence to deliver their new role, 80 particularly in an overstretched system 5 . It additionally deviates from traditional training 81 pathways and exposures, and has the potential to negatively impact trainees' professional 82 development in (at least) the short to medium term. The impact of reduced patient 83 throughput and workforce redeployment on training may be even more significant in surgical 84 specialties, wherein consistent hands-on practice is required for the development and We performed a national survey of cardiothoracic surgical trainees in the United Kingdom 93 (UK) three weeks after the implementation of national lockdown procedures, to assess the 94 impact of the Covid-19 pandemic on their wellbeing, daily practice, training exposures and 95 related concerns. To the best of our knowledge, this is the first paper to report on a 96 comprehensive, multi-faceted evaluation of trainees' experiences during this pandemic. Training Structure and Terminology Cardiothoracic surgeons in the United Kingdom currently train for at least ten years after 100 achieving a primary medical qualification, with entry through a national selection process. The specialist training programme is of six to eight years' duration, depending on the stage For continuous data, intergroup comparison was performed using the student t-test or Mann- Whitney test/pairwise Wilcoxon Rank Sums test, depending on the distribution of data. Differences between groups for categorical data were assessed using the Fisher's exact test Missing data were excluded from analyses. Correction for multiple comparisons was applied 155 using the Benjamini-Hochberg method. All analyses were performed using the R 3.6.2 program via RStudio, Inc for Windows, R Of these, immediately prior to the onset of the pandemic, 53% (n = 40) were working in adult 163 cardiac surgery, 28% (n = 21) in general thoracic surgery, 5% (n = 4) in mixed cardiothoracic 164 practice, and the remaining 13% (n = 10) in other specialties. At the time of reporting, 45% (n = 34) of trainees were continuing to work exclusively in their 190 original specialty area, whilst 34% (n = 26) were spending less than half their working hours 191 caring for patients in their original specialty. There was no difference in the likelihood of 192 being redeployed between early or late stages of training (see Table 1 ). Of the 42 trainees who were redeployed, 38% (n = 16) were newly covering both cardiac The reported engagement with and contribution to Covid-19 specific academic work was 211 highly variable; with 66% (n = 50) currently having no participation, but with 76% of these 12 colleagues (n = 38/50) expressing an interest in developing this role. Of those who reported 213 being research-or audit-active in this field, 77% (n = 20/26) are primarily engaged in national 214 or international collaborative initiatives. There was no difference noted between early and 215 late stage trainees' engagement with Covid-19 research (see Table 1 ). The majority of trainees report being somewhat (25%, n = 19) or very (63%, n = 48) 218 concerned about the impact of the pandemic on their learning and progression through 219 structured training. There was no association between trainee seniority and declared 220 concern (see Table 1 ). Most (57%, n = 43) feel that their current role offers little to no relevant learning 222 opportunities, and is in fact a deterrent to their professional development. Only 14% (n = 11) 223 report a comparable or above average-value learning experience. There is also very poor Table 4 . The impact of the Covid-19 pandemic on patient outcomes has been widely documented, 258 albeit still poorly quantified 12 A significant direct and indirect morbidity and mortality burden 259 is expected to continue for many months. Whilst risk is inherent in clinical practice, and should not prejudice the care delivered, it is 269 essential to empower staff by providing adequate levels of personal protection 14 . It is 270 disappointing to note that a majority of our trainees report not having consistent or reliable 271 access to appropriate PPE, and that access to testing for patients and staff remains heavily 272 restricted. Clinicians, including trainees, will continue to be exposed to patients infected with recognise that this pandemic has facilitated the emergence of clinical leaders, also from 308 amongst the trainee body. It has also exposed the potential for efficiently effecting changes 309 in systems previously apparently set in stone. The sometimes-intangible learning from these unique exposures and contributions must be A pragmatic view should be taken to facilitate, support and promote Covid-19 related research participation and collaboration. Trainee progression should be considered on an individual basis, with flexibility and mutual agreement on duration and purpose of any extension period. 19-outbreak-a-pandemic 373 2. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? 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