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Factors Associated With General Surgery Residents’ Operative Experience During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How did general surgery resident operative volume change during the first 4 months of the US COVID-19 pandemic, and were all postgraduate year levels equally affected?

Findings  In this review of 1358 resident case logs, general surgery resident operative volume declined by 33.5% in March to June 2020 compared with March to June 2018 and 2019 and affected residents in every level of training.

Meaning  These findings illustrate the significant negative effect of the COVID-19 pandemic on general surgery resident operative experience, highlighting the importance of identifying future mitigation strategies.

Abstract

Importance  The suspension of elective operations in March 2020 to prepare for the COVID-19 surge posed significant challenges to resident education. To mitigate the potential negative effects of COVID-19 on surgical education, it is important to quantify how the pandemic influenced resident operative volume.

Objective  To examine the association of the pandemic with general surgical residents’ operative experience by postgraduate year (PGY) and case type and to evaluate if certain institutional characteristics were associated with a greater decline in surgical volume.

Design, Setting, and Participants  This retrospective review included residents’ operative logs from 3 consecutive academic years (2017-2018, 2018-2019, and 2019-2020) from 16 general surgery programs. Data collected included total major cases, case type, and PGY. Faculty completed a survey about program demographics and COVID-19 response. Data on race were not collected. Operative volumes from March to June 2020 were compared with the same period during 2018 and 2019. Data were analyzed using Kruskal-Wallis test adjusted for within-program correlations.

Main Outcome and Measures  Total major cases performed by each resident during the first 4 months of the pandemic.

Results  A total of 1368 case logs were analyzed. There was a 33.5% reduction in total major cases performed in March to June 2020 compared with 2018 and 2019 (45.0 [95% CI, 36.1-53.9] vs 67.7 [95% CI, 62.0-72.2]; P < .001), which significantly affected every PGY. All case types were significantly reduced in 2020 except liver, pancreas, small intestine, and trauma cases. There was a 10.2% reduction in operative volume during the 2019-2020 academic year compared with the 2 previous years (192.3 [95% CI, 178.5-206.1] vs 213.8 [95% CI, 203.6-223.9]; P < .001). Level 1 trauma centers (49.5 vs 68.5; 27.7%) had a significantly lower reduction in case volume than non–level 1 trauma centers (33.9 vs 63.0; 46%) (P = .03).

Conclusions and Relevance  In this study of operative logs of general surgery residents in 16 US programs from 2017 to 2020, the first 4 months of the COVID-19 pandemic was associated with a significant reduction in operative experience, which affected every PGY and most case types. Level 1 trauma centers were less affected than non–level 1 centers. If this trend continues, the effect on surgical training may be even more detrimental.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Farin Amersi, MD, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, #8215NT, Los Angeles, CA 90048 (farin.amersi@cshs.org).

Accepted for Publication: March 4, 2021.

Published Online: April 30, 2021. doi:10.1001/jamasurg.2021.1978

Author Contributions: Dr Amersi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Purdy, de Virgilio, Shields Frey, Neville, Donahue, Calhoun, Spain, Amersi.

Acquisition, analysis, or interpretation of data: Purdy, de Virgilio, Kaji, Shields Frey, Lee-Kong, Inaba, Gauvin, Neville, Smith, Salcedo, Calhoun, Poola, Namm, Spain, Dickinson, Tanner, Wolfe, Amersi.

Drafting of the manuscript: Purdy, de Virgilio, Tanner, Amersi.

Critical revision of the manuscript for important intellectual content: Purdy, de Virgilio, Kaji, Shields Frey, Lee-Kong, Inaba, Gauvin, Neville, Donahue, Smith, Salcedo, Calhoun, Poola, Namm, Spain, Dickinson, Wolfe, Amersi.

Statistical analysis: Kaji.

Administrative, technical, or material support: Purdy, Shields Frey, Lee-Kong, Gauvin, Neville, Donahue, Smith, Namm, Spain, Dickinson, Tanner.

Supervision: de Virgilio, Shields Frey, Calhoun, Poola, Amersi.

Conflict of Interest Disclosures: Dr Smith reports personal fees from Stryker Endoscopy outside the submitted work. No other disclosures were reported.

Disclaimer: Dr Kaji is Statistical Editor of JAMA Surgery but was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Meeting Presentation: This study was accepted for presentation at the 92nd Annual Meeting of the Pacific Coast Surgical Association that was planned for February 18-20, 2021, in Monterey, California. However, owing to the COVID-19 pandemic, the meeting was canceled.

References
1.
World Health Organization. Archived: WHO timeline-COVID-19. Published April 27, 2020. Accessed October 5, 2020. https://www.who.int/news/item/27-04-2020-who-timeline---covid-19
2.
FEMA. COVID-19 emergency declaration. Press release. Published March 14, 2020. Accessed October 5, 2020. https://www.fema.gov/news-release/20200726/covid-19-emergency-declaration
3.
American College of Surgeons. COVID-19: recommendations for management of elective surgical procedures. Published March 13, 2020. Accessed October 5, 2020. https://www.facs.org/covid-19/clinical-guidance/elective-surgery
4.
Adesoye  T , Davis  CH , Del Calvo  H ,  et al.  Optimization of surgical resident safety and education during the COVID-19 pandemic: lessons learned.   J Surg Educ. 2021;78(1):315-320. doi:10.1016/j.jsurg.2020.06.040PubMedGoogle ScholarCrossref
5.
Coyan  GN , Aranda-Michel  E , Kilic  A ,  et al.  The impact of COVID‐19 on thoracic surgery residency programs in the US: a program director survey.   J Card Surg. Published online August 16, 2020. doi:10.1111/jocs.14954Google Scholar
6.
Juprasert  JM , Gray  KD , Moore  MD ,  et al.  Restructuring of a general surgery residency program in an epicenter of the coronavirus disease 2019 pandemic: lessons from New York City.   JAMA Surg. 2020;155(9):870-875. doi:10.1001/jamasurg.2020.3107PubMedGoogle ScholarCrossref
7.
Meneses  E , McKenney  M , Elkbuli  A .  Reforming our general surgery residency program at an urban level 1 trauma center during the COVID-19 pandemic: towards maintaining resident safety and wellbeing.   Am J Surg. 2020;220(4):847-849. doi:10.1016/j.amjsurg.2020.06.001PubMedGoogle ScholarCrossref
8.
Nassar  AH , Zern  NK , McIntyre  LK ,  et al.  Emergency restructuring of a general surgery residency program during the coronavirus disease 2019 pandemic: the University of Washington Experience.   JAMA Surg. 2020;155(7):624-627. doi:10.1001/jamasurg.2020.1219PubMedGoogle ScholarCrossref
9.
Chick  RC , Clifton  GT , Peace  KM ,  et al.  Using technology to maintain the education of residents during the COVID-19 pandemic.   J Surg Educ. 2020;77(4):729-732. doi:10.1016/j.jsurg.2020.03.018PubMedGoogle ScholarCrossref
10.
White  EM , Shaughnessy  MP , Esposito  AC , Slade  MD , Korah  M , Yoo  PS .  Surgical education in the time of COVID: understanding the early response of surgical training programs to the novel coronavirus pandemic.   J Surg Educ. 2021;78(2):412-421. doi:10.1016/j.jsurg.2020.07.036PubMedGoogle ScholarCrossref
11.
Zarzaur  BL , Stahl  CC , Greenberg  JA , Savage  SA , Minter  RM .  Blueprint for restructuring a department of surgery in concert with the health care system during a pandemic: the University of Wisconsin Experience.   JAMA Surg. 2020;155(7):628-635. doi:10.1001/jamasurg.2020.1386PubMedGoogle ScholarCrossref
12.
Mattar  SG , Alseidi  AA , Jones  DB ,  et al.  General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors.   Ann Surg. 2013;258(3):440-449. doi:10.1097/SLA.0b013e3182a191caPubMedGoogle ScholarCrossref
13.
Napolitano  LM , Savarise  M , Paramo  JC ,  et al.  Are general surgery residents ready to practice? a survey of the American College of Surgeons Board of Governors and Young Fellows Association.   J Am Coll Surg. 2014;218(5):1063-1072.e31. doi:10.1016/j.jamcollsurg.2014.02.001PubMedGoogle ScholarCrossref
14.
Collins  C , Mahuron  K , Bongiovanni  T , Lancaster  E , Sosa  JA , Wick  E .  Stress and the surgical resident in the COVID-19 pandemic.   J Surg Educ. 2021;78(2):422-430. doi:10.1016/j.jsurg.2020.07.031PubMedGoogle ScholarCrossref
15.
Aziz  H , James  T , Remulla  D ,  et al.  Effect of COVID-19 on surgical training across the United States: a national survey of general surgery residents.   J Surg Educ. 2021;78(2):431-43. doi:10.1016/j.jsurg.2020.07.037PubMedGoogle ScholarCrossref
16.
Pelargos  PE , Chakraborty  A , Zhao  YD , Smith  ZA , Dunn  IF , Bauer  AM .  An evaluation of neurosurgical resident education and sentiment during the coronavirus disease 2019 pandemic: a North American Survey.   World Neurosurg. 2020;140(5):e381-e386. doi:10.1016/j.wneu.2020.05.263PubMedGoogle Scholar
17.
Abdallah  HO , Zhao  C , Kaufman  E ,  et al.  Increased firearm injury during the COVID-19 pandemic: a hidden urban burden.   J Am Coll Surg. 2021;232(2):159-168.e3. doi:10.1016/j.jamcollsurg.2020.09.028PubMedGoogle ScholarCrossref
18.
American Board of Surgery. FAQs - 2020 hardship modifications to general surgery training requirements. Accessed October 5, 2020. https://www.absurgery.org/default.jsp?faq_gshardship
19.
Centers for Disease Control and Prevention. COVID data tracker. Accessed December 2, 2020. https://covid.cdc.gov/covid-data-tracker/index.html#cases_casesinlast7days
20.
Centers for Disease Control and Prevention. Past pandemics. Accessed October 25, 2020. https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html
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