EDITORIAL COMMENT

Abstract

The initial and subsequent waves of the COVID-19 pandemic have required medical and surgical training institutions to pivot to alternative teaching and learning techniques. As such, clinical and surgical experiences have been affected in many institutions globally. Despite these changes, surgical residents are tasked with competently reaching milestones required to progress through training. Effectively managing these changes while navigating the challenges of the pandemic itself can be a daunting task for residents, potentially impacting their overall quality of life. This online survey-based study evaluated the clinical and non–clinical experiences of urology residents in the US and 3 European countries (Italy, France, and Portugal [EU]) to assess the impact of these pedagogical changes on everyday life, particularly with respect to well-being. A 72-item survey was developed to assess burnout, anxiety, depression, loneliness, quality of life, and professional fulfillment using validated instruments, and included 38 novel pandemic-specific questions. The survey, activated in September 2020, was retrospective, as it asked residents to compare experiences prior to and after the initial peak of the pandemic. The same author group conducted a study on urology resident burnout in US and EU urology residents (2019),1Marchalik D Goldman CC Carvalho FFL et al.Resident burnout in USA and European urology residents: an international concern.BJU Int. 2019; 124: 349-356https://doi.org/10.1111/bju.14774Google Scholar and the same residency program contacts were used for the current survey's distribution; however, the current study included only one-third of all US programs. The response rate was low (16.7%) with missing data for multiple questions, decreasing the sample size for some analyses. With lengthy surveys, this is not uncommon, as survey fatigue can play a role.2Stavseth MR Clausen T Røislien J. How handling missing data may impact conclusions: a comparison of six different imputation methods for categorical questionnaire data.SAGE Open Med. 2019; 7 (2050312118822912)Google Scholar,3de Koning R Egiz A Kotecha J et al.Survey fatigue during the covid-19 pandemic: an analysis of neurosurgery survey response rates.Front Surg. 2021; 8690680https://doi.org/10.3389/fsurg.2021.690680Google Scholar Importantly, as the authors note, respondents included PGY-1 residents (n = 37; 17%) who may not have been able to adequately answer some of the questions due to inexperience. Several findings were consistent with previously reported studies. Respondents spent significantly fewer days per week in the hospital (1.6) and the operating room (0.96). Ammann and colleagues (2022) reported a significant pandemic-related decrease in general surgery major cases between residents in 2019 and 2020 of 1.5% fewer cases (P = .011), which was magnified during the chief year with 8.4% fewer cases (P < .001).4Ammann AM Cortez AR Vaysburg DM et al.Examining the impact of COVID-19 restrictions on the operative volumes of US general surgery residents.Surgery. 2022; 171: 354-359https://doi.org/10.1016/j.surg.2021.06.003Google Scholar It would be interesting to see the current study's data stratified by year of training, which could provide a clearer picture of residents’ experiences. As the authors hypothesized, there was no significant rise in burnout or depression, potentially due to many programs reporting increased physical health and wellness supports.5Rosen GH Murray KS Greene KL Pruthi RS Richstone L Mirza M. Effect of COVID-19 on urology residency training: a nationwide survey of program directors by the society of academic urologists.J Urol. 2020; 204: 1039-1045https://doi.org/10.1097/JU.0000000000001155Google Scholar While these are encouraging data, it is important to consider that each country represented experienced different pandemic-related circumstances, including lockdowns and other restrictions. These may have varied significantly depending upon the location within the country, especially in the US where restrictions were largely mandated by state and local governments, which could potentially influence these findings. Future research on the impact of the COVID-19 pandemic on the well-being of urology residents’ worldwide will be important, especially as the pandemic continues. There is much to learn about how training modifications affect many of the variables observed in this study, and the more data we have, the more equipped we will be to adapt our curricula to better train our residents.