This study shows the many effects during the start of the COVID-19 pandemic on personal and professional lives of surgical residents in Flanders (Belgium), a severely affected region during that period. One in three residents were not allowed on MDOMs and six in ten residents had no scientific meetings at all. Fifty-six percent of the residents indicate more than 50% reduction of operating theater time compared to their time before the outbreak, and younger residents were mostly engaged in care for COVID-19 patients. Residents had to work less in general but were more on call. Overall, the perceived impact on surgical training was negative for 8 in 10 residents. Objective data on performed surgical case volume indicate that younger year residents had less surgical exposure than before the COVID-period. Older year residents were still able to perform surgeries and had no statistical difference in case volume. As the SARS-CoV-2 virus emerged all over the world, healthcare systems had to change rapidly to support COVID-19 patients and to keep other care ongoing. Residency programs had to be postponed and changed accordingly to ensure quality education of residents [9, 14]. For surgical residents in particular, COVID-19 has affected their volume of performed surgeries during the lockdown, as most non-emergent procedures were cancelled [15]. Few studies assessed the effect of this impact on surgical residents’ life and education [16].
The impact on teaching activities for residents in Belgian hospitals was high: 55% of them no longer had any scientific meetings organized nor department-specific meetings and MDOMs. Also globally, hospitals struggle to preserve academic teaching for their residents during the pandemic [17–20]. We observed that more residents were admitted to multidisciplinary meetings in university hospitals. This can be explained by the academic function of these hospitals and their larger number of MDOMs. Interestingly, less than 20% of outpatient contacts was organized by video- or teleconsultation. This could be due to the limited experience in Belgium with this formula [20]. The Belgian government invested during the COVID-19 crisis in the further development of video consultations and the reimbursement of it so that it can continue after the pandemic.
Most residents in regional hospitals had to work less during the pandemic than before, although they had higher on call frequency. This could be explained by the deployment of residents to emergency units and newly created COVID-19 wards. In university hospitals, the total number of working hours per week was comparable to regional hospitals but the increase of their on-call frequency was less than in regional hospitals. This could be due to the fact that university hospitals in Belgium have the largest number of residents and could therefore count on a larger resident pool to fill in the extra shifts. The same trend is seen in other countries and resident programs [7]. It is remarkable that despite the high availability of personal protective material, still 12% of the residents were tested positive for COVID-19. This emphasizes the need for screening of healthcare workers. In Belgium, there is no generalized testing for healthcare staff and as such, the number does not include asymptomatic residents. A future study on immunity by antibodies may reflect the true infection rate more accurately [16]. The overall perceived negative impact on surgical education and residents’ personal life is in line with previous studies [21–23] and shows the need for attention on this topic in the further evolution of the pandemic.
This study also sought to determine the impact of COVID-19 on their total number of performed surgeries by comparing the first COVID wave time period and its corresponding period in the year before. Younger year residents (second, third and fourth year) experienced a significant decrease in their performed surgeries during the COVID period. This could be explained by the fact that these residents were redeployed to other wards and emergency units. Older year residents (fifth and sixth year) did not experience a significant decrease in surgeries and a possible explanation could be found in the fact that they have a more independent degree in the operating theater and they could perform the emergency surgeries. This is in line with other countries where we see that surgical time for residents decreased sharply [14, 24–26].
This study has several strengths. The overall response rate of 46% and the response rate per specialty are high compared to other studies [27–30]. To our knowledge, this study is the first to calculate differences in performed surgeries between different training years based on objective registered data in 2 time periods. Most other studies used self-reported data from respondents in the survey [11, 31, 32]. This study also has some limitations. Not all hospitals were affected by the same number of COVID-19 hospitalizations and impact on structuring in hospitals could vary. We anticipated on this by asking the number of admitted COVID-19 patients in the hospital, but we did not exclude low-admission hospitals in our analysis. Nevertheless, more than 85% of respondents worked in a hospital with more than 50 COVID-19 admissions. Secondly, this study is prone to recall bias due to its respective nature. We minimised this bias in the calculation of number of performed surgeries by using the independent registry platform (Medbook®) to collect the data. Lastly, some of the specialty groups are relatively small (e.g. reconstructive surgery). We achieved good response rate for all specialties; however, we acknowledge that comparing disproportionate groups is a limitation for this study and for this reason we presented the data of the survey on an aggregated level for all surgical disciplines.