key: cord-1052645-8k4zegtu
authors: Abdelrazek, Mohamed; Eldahshoury, Tarek; Badawy, Mohamed S.; Gad, Ahmed M.
title: The Effect of COVID-19 Pandemic on Plastic Surgery Practice in a Tertiary Health Care Center in Egypt
date: 2021-06-09
journal: Plast Reconstr Surg
DOI: 10.1097/prs.0000000000008028
sha: f7865e9d19ce15fb65c4b647fe320a2c273a9491
doc_id: 1052645
cord_uid: 8k4zegtu

nan

surgical practice all over the world. These challenges included limited theatre spaces, surgical and anesthetic staff, and resources and efforts to limit contacts by decreasing hospital visits. 1 Different policies and measures have been implemented by institutions all over the world, 2,3 and learning about this variability helps in better management of future events. In this article, we present our experience in the plastic surgery department of one of the largest tertiary care hospitals in Cairo, Egypt.

The policy adopted by the Egyptian health care system involved screening of all patients, with separation of COVID-19 and non-COVID-19 patients and treating them in separate hospitals. 4 At our institution, Ain Shams University, screening has been done using full blood count, computed tomography chest scans, and rapid COVID-19 testing. After the initial screening, suspected COVID-19 as well as respiratory symptomatic cases have been offered the COVID-19 polymerase chain reaction test as well. Patients with confirmed COVID-19 cases are then transferred to COVID-19 hospitals.

Efforts to decrease patients' hospital visits have been made to decrease pressure on overwhelmed hospital departments and to decrease contact and transmission of the disease. All elective surgeries have been stopped. Only trauma and urgent tumor patients have been offered surgery.

For trauma patients, we set minor procedure rooms in the emergency department so that patients could have definitive management on their first visit. These patients did not have to undergo the COVID-19 screening investigations. We extended the use of wideawake, local anesthesia, no tourniquet (WALANT) treatment in these rooms to include simple tendon, digital nerve, and fracture injuries. Reusable splints and absorbable sutures have been used. We have avoided buried Kirschner wires. Patients and relatives looking after them have been taught wound care and given physiotherapy instructions and exercises. Maxillofacial procedures are considered highrisk procedures. 5 Wearing level 3 personal protective equipment in all cases has been mandatory. Most zygomatomaxillary, nasal, and orbital fractures have been managed conservatively. Even mandibular fractures have been managed with the minimum amount of intervention possible. For burn patients, our burn unit has been used to manage non-COVID-19 burn patients. Burn patients with suspected or confirmed COVID-19 have been transferred to a quarantine hospital regardless of the percentage of the body burned, with recruitment of burn surgery staff to take care of these patients there.

For cancer patients, surgeries for slowly progressing tumors, such as small, recent skin basal cell carcinomas, have been postponed. Head and neck cancer surgeries imposed a great challenge to our department due to the high risk of COVID-19 transmission and the need for intensive care unit beds postoperatively. For breast cancer patients, only implant-based

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The authors have no financial interest to declare in relation to the content of this article.

The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

Step 1 on the Integrated Plastic Surgery Match: Perspectives from a Program Director and Medical Student I ntegrated plastic surgery ranks consistently among the most competitive specialties to match into, with increasingly more impressive applications coming each year. 1 The announcement that the United States Medical Licensing Examination (USMLE) Step 1 will become pass/fail in 2022 has introduced unprecedented change regarding the metrics used to stratify applicants. In this article, we discuss this topic from the perspectives of a prospective applicant and a program director.The National Resident Matching Program's "Charting Outcomes in the Match" and "Program Director Survey" have provided insight into changes in applicant characteristics and metrics valued by program directors, respectively. Tadisina et al. 2 described the rising integrated plastic surgery match rate and similarly trending applicant USMLE Step 2 Clinical Knowledge scores, number of publications, and conference presentations and abstracts, but found no significant increase in USMLE Step 1 score. 2 Because objective metrics such as examination scores and Alpha Omega Alpha Honor Society membership status have increased/remained prevalent, the authors concluded that, to increase match likelihood, applicants should maximize factors resonating through letters of recommendation, such as work ethic during subinternships. In our analysis of newly released 2020 data, 3 we observed an upward trend in Step 1 scores of matched applicants (Fig. 1) .From the medical student perspective, these changes represent an opportunity for future applicants to commit greater preclinical time to plastic surgery involvement rather than routine basic science material anecdotally considered exorbitant. By shadowing, research, and leadership opportunities, medical students will potentially become involved in academic networking from an early stage. Weissler and Taub's 4 response to Tadisina et al. discussed self-selection of the highest-scoring USMLE applicants as a possible cause for the observed rising plastic surgery match rate. Although a pass/fail Step 1 score will dilute opportunities to demonstrate preclinical proficiency, clinical knowledge indications (Step 2 Clinical Knowledge/clerkship grades), research productivity, and subinternships are likely to hold greater weight.From the program director perspective, these changes present a challenge to common currently adopted selection and screening criteria for residency applications, an opportunity for developing better criteria in this setting, and a potential threat to the level of basic science understanding of plastic surgery trainees. Excellence in USMLE Step 1 score does not predict excellence in residency performance. Developing a plastic surgery residency admissions test may be a better correlate