Table 1 Studies that met the inclusion criteria after full-text review (n = 29)

From: The impact of COVID-19 on surgical training: a systematic review

Author Country Size Speciality Method Response rate Clinical activity impact
Abdessater France 275 Urology National survey 55.5% 85.5% felt the quality of their work had been affected
91.6% reported feeling stressed
Risk factors for stress were past medical history (OR 2.57, 95% CI 1.31–5.98) and COVID-19 patients management (OR 1.85, 95% CI 0.98–3.59)
Alhaj Canada, USA, Kuwait, Saudi Arabia, Serbia, Italy 52 Neurosurgery Cross sectional survey 98.1% 98% felt training was affected
90% felt mental health was affected
100% reported their social life was affected
Amparore Italy 351 Urology National survey 60.8% 7.7% involved on COVID-19 wards
41.4% reduction in on call duties, 74.1% reduction in diagnostic procedures, 62.1% reduction in endoscopic surgery, 57.8% in open surgery and 44.2% for minimally invasive surgery
For final year trainees, reduction from 84–44% of minimally invasive ops (p < 0.001) and 82 to 44% (p = 0.002) of major surgery
85.2% reported at least 2 h per day for smart learning purposes
An USA 121 Orthopaedics Survey 82% 1 out of 5 centres had redeployed trainees to support patients with COVID-19
3 out of 5 residency programmes withdrew trainees from all outpatient activity
20% using mental health resources to support wellbeing
Educational activity has continued via video-conferencing
Aziz USA 1102 General surgery Survey Not reported 77% reported daily rounds and floor duties were delegated to other members of staff
40.6% reported that they were not allowed in the operating room for cases considered high risk of COVID-19 transmission
Significant decrease in the number of operative cases per week
80.67% attended no outpatient clinic activity during the pandemic
80.6% reported all teaching was provided by online platforms
33.1% reported more burnout than pre-COVID pandemic
Bernardi Italy 3 General surgery Operative log book review N/a Number of interventions performed significantly decreased (36.2 vs 14.0, p = 0.033)
Mean number of surgeries as first operator decreased from 11.8 ± 7.9 to 4.5 ± 5.8 (p = 0.099)
Non-significant trend towards decreased participation in all surgeries
Education provided via webinars and other online platforms
Brar USA 33 programme directors Oral and maxillofacial surgery Survey 35% All programmes had suspended elective and non-urgent operations
40% reported using telemedicine
73% reported resources for resident wellness and stress reduction
Education continued on digital platforms
Burks USA 1 programme Neurosurgery Operative case review n/a Operative case totals were lower at all levels of training
Significant decrease in cases compared to year before (p < 0.01)
Collins USA 73 General and plastic surgery Survey 73.7% 90% expressed concern about decline in operative exposure
Estimated reduction in operative volume of 63.3%
Residents were more concerned about the health of loved ones as opposed to their own risk of contracting COVID-19 (p < 0.01)
English UK 3 General surgery Operative log book review N/a Operative training continued in emergency cases
Change to more open compared to laparoscopic procedures
Fero USA 64 programme leaders, 106 trainees Urology Cross sectional survey 20% 20% redeployed
Decreased surgical volume 83–100%
79% perceive negative impact on training
Increase use of teleheath (99%), decrease size of inpatient trainee teams (90%)
Transition to virtual learning
Ferrara 32 countries 504 Ophthalmology Survey Not reported 55.2% of trainees felt the pandemic had had a severe impact on training
76.4% reported more than a 50% reduction in clinical activity
67.7% attended web-based teaching
Figueroa Chile 100 Orthopaedics Survey 90.9% 86% using online educational tools
13% reported lack of practical education was a problem with online learning
30% felt all non-practical education should be performed using online tools
Givi USA 31 trainees
37 programme directors
Otolaryngology Survey
Operative log review
Not reported 70% of program directors reported a 50–90% reduction in elective cases, but 81% stated fellows continued to participate in oncology cases
86% of fellow-led clinics cancelled
Operative log comparison was similar to pre-COVID-19 times
82% of fellows have met the requisite number of operative cases for certification
97% reported weekly participation in virtual tumour board series
Guo USA 175 Otolaryngology Survey 83% 98.3% reported a decrease in clinical activities
68% expressed concern in the ability to receive adequate surgical training
54.7% of senior trainees felt the pandemic had had a negative impact on future job prospects
Huntley USA 161 trainees, 13 programme directors Oral + maxillofacial Survey 83% 14% redeployed
96.5% reported modifications to training programme
66% not concerned with meeting graduate requirements. Greatest concern was for trainees scheduled to graduate in 2022 (60%)
88.8% felt operative experience been affected, with mean decrease in operative experience of 67%
97.7% stated elective cases stopped altogether
94.2% stated move to virtual didactics
Kapila 10 countries 86 Plastic surgery Survey Not reported 85% of all trainees felt their training had suffered
Decreased surgical activity was reported by 86% of Belgian trainees and 73% of international trainees
46% of Belgian trainees redeployed compared to 27% of international trainees
Anxiety regarding own health and that of loved ones was reported by 54% of Belgian and 69% of international trainees
Khusid USA 332 Urology National survey 20% 22% redeployed
Factors significantly associated with concerns over future operative autonomy were ability to reach case requirements, cancellation of elective cases and PGY4 trainees
Risk factors for depression were local COVID-19 severity, personal history of COVID-19 infection and concerns over operative autonomy
Mishra India 716 Ophthalmology Survey Not reported 24.6% redeployed
80.7% felt training negatively impacted
75.7% thought online teaching was useful
54.8% reported higher levels of stress, 46.5% felt ‘unhappy’
Munjal 22 countries 66 residents, 30 faculty Otolaryngology and paediatric otolaryngology Survey Not reported 91.7% reported all elective cases had been cancelled
86.4% felt all levels of residents were affected equally
87.5% reported that no supplementary operative education is being provided
41.7% reported that all teaching seminars are virtual
Osama Pakistan 112 All surgical specialties Survey Not reported 86.6% felt hands-on experience has been adversely affected
82.1% reported clinical exposure has been affected
61% were concerned about transmitting the virus to loved ones
Significant reduction in working hours per week (p < 0.001)
Burnout was significantly reduced compared to pre pandemic (p < 0.001)
Paesano Latin America
Spain
148 Urology Survey 100% 15% said urology activity completely ceased and staff redeployed 82% said activity of urology department significantly reduced
75% said surgical training has been completely affected
65% felt academic raining has been partially or completed affected
Megaloikonomos 23 European countries 327 Orthopaedics Survey   58.6% felt surgical training was significantly impaired
58.2% were concerned about meeting annual training goals
In 57.1% of institutions only essential activities were performed
20.9% redeployed
Pelargos USA
Canada
197 Neurosurgery Survey Not reported 35.1% providing non-specialty care to COVID-19 patients
82% inpatient and outpatient volumes reduced
91% reported work responsibility had decreased, with significant decrease in work hours (p < 0.001)
33.7% concerned would negatively affect residency education, with senior trainees more likely to be concerned p = 0.028
8.2% concerned would affect overall case numbers
26.5% concerned limit ability to get desired employment or fellowship
Significant increase in number of trainees spending > 4 hours on didactics p < 0.0001
Rosen USA 65 programme directors Urology Survey 45% 26% redeployment
60% programmes report concern trainees will not meet case minimums
Reduction of trainee presence reported by 92% of programs
Significant decrease in patient-contact time (4.7 to 2.1 days/week, p < 0.001)
48% of programmes reported education had been negatively impacted
White USA 84 programme directors General surgery Survey 33.6% 44% reported attendings were operating without resident presence
All programmes reduced the number of residents on rounds
90.5% reported the use of telehealth clinics
86.9% reported resident teaching moved online
8.3% reported redeployment
Zheng USA 24 General surgery Survey 61.5% The biggest concern amongst chief residents was the potential delay in board examinations
93.3% of attending surgeons suggested a personalised approach for additional training
Zingaretti Italy 115 Plastic surgery National survey 72% Majority feel lack of training is detrimental to professional growth
The majority were using webinars to keep knowledge updated
Zoia Italy 192 Neurosurgery Survey 58% 72.4% reported reduced time in neurosurgical department
78.6% performed less operations, 16.1% performed no operations
Production of scientific papers or research projects increased in 55.7% of cases