Here, we show that the pediatric surgery residency program at our institution has been significantly affected by the COVID-19 pandemic. Our findings further confirmed previous reports [2, 3]. However, there are several novelties of our study: 1) pediatric surgery residency program (vs. plastic surgery training ); 2) developing country (vs. developed countries [2, 3, 4]); 3) prospective design using questionnaire (vs. retrospective design ); and 4) comprehensively developed the questionnaire into four aspects that might affect the residency program: a) the perspectives of residents about COVID-19 infection; b) learning process; c) academic evaluations; and d) residents’ suggestions for residency program improvement (vs. general questionnaire  or authors’ perspective ).
All residents are worried they will become infected by COVID-19 during their residency program in the hospital. Accordingly, they agreed that elective surgeries should be postponed during the pandemic. When compared with the importance of the residents safeguarding the well-being of their families from the possibility of getting cross-infected by COVID-19 due to the residents’ potential exposure at the hospital, the training program was no longer considered as important anymore for the residents .
Moreover, since the COVID-19 pandemic, we have shifted our morning reporting from off-line to online meetings. Most residents are satisfied with the changes, although some residents thought that offline morning reporting was better to gain skills and knowledge than online meetings (Fig. 1). Interestingly, approximately 5% of residents used the virtual didactic methods for their learning process during the pandemic, while they never used it before the outbreak. The use of virtual didactic methods is not common in pediatric surgery, at least in our institution. A recent study suggested that virtual methods will not substitute for conventional didactic approaches, but they will give advantages for residents to encourage their positive eagerness and enthusiasm .
We also evaluated the learning process regarding the competence gained during the pandemic. Our data showed that most residents believe that their competence is declining during the pandemic. This finding might be associated with the fact that almost all elective surgical cases were postponed during the pandemic. Postponing elective surgeries occurred in every country affected by the COVID-19, including the USA  and Australia . Most residents agreed that live view surgery with virtual outpatient services and ward rounds will be useful to solve this challenge.
While there are limited activities to gain the skills of pediatric surgery during the pandemic, intriguingly, most residents claimed that this outbreak gave them more time to finish their academic assignments, including extended study time for level up examinations and completion of their thesis. These advantages might be related to the policy that restricted the number of residents during the outpatient services, ward rounds and surgical procedures. As a result, most of them stayed at home, and only a limited number of rotating residents (i.e., three per round) were allowed to perform residency tasks each day in the hospital.
One of the residents’ suggestions was to gradually increase the number of elective surgeries. This response reflects that it is not clear whether the COVID-19 pandemic will end in a few months or even in the next few years, and as a proper response, our government declared a “new normal” policy on June 1, 2020 to begin the adaptations of the daily activities to the COVID-19 pandemic, involving clinical and surgical services . Our pediatric surgery services have adapted our scheduling practices as well starting on June 8, 2020, when we began to perform a) only one major surgery every week on Tuesdays; and b) two or three minor procedures on another working day each week .