Impact of COVID-19 pandemic on microsurgery fellowships

Abstract

The COVID-19 pandemic, has had an unprecedented effect on the NHS, but also across global healthcare systems. This level of disruption and redesigning of plastic surgery services has only been compared to major historical events, such as world wars and other disasters.1Nikkhah M.D. COVID-19 The Great Disruptor.J Plast Reconstr Aesthet Surg. 2020; (S1748-6815-0): 30271https://doi.org/10.1016/j.bjps.2020.05.083Abstract Full Text Full Text PDF Scopus (8) Google Scholar Microsurgery services have had to carry on being available for lower limb injuries and head and neck cancers, even during the peak of the disease.2Ramella V. Papa G. Bottosso S. Cazzato V. Arnež Z.M. Microsurgical reconstruction in the time of COVID-19,.Microsurgery. 2020; 15 (doi: 10.1002/micr.3060)https://doi.org/10.1002/micr.30604Crossref Scopus (5) Google Scholar At the same time, outpatient clinics and elective operating lists were reduced dramatically, due to hospital staff reassignments and to minimise the risk of patient exposure to the virus. Elective surgery, including immediate breast reconstructions, were held back and the guidance from world surgical societies was to delay reconstructive procedures.3Pace B.D. Benson J.R. Malata C.M. Breast reconstruction and the COVID-19 pandemic: a viewpoint.J Plast Reconstr Aesthet Surg. 2020; (S1748-6815-5): 30217https://doi.org/10.1016/j.bjps.2020.05.033Abstract Full Text Full Text PDF Scopus (12) Google Scholar As we enter a long recovery phase in June 2020, the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) published guidance on how to safely resume breast reconstruction services.4http://www.bapras.org.uk/docs/default-source/default-document-library/restarting-breast-recon-pathways.pdf?sfvrsn=2.Google Scholar One of the main highlighted issues, has been the impact on training after this long period of surgical inactivity. This will potentially be aggravated by the policy of strict consultant delivered services during the recovery period. The aim of this study was to quantify the impact of the pandemic on microsurgery fellowships and potentially offer advice on mitigating some of its adverse effects. We developed a questionnaire that was distributed amongst 5 plastic surgery units in London, known for offering microsurgery fellowship programmes: Royal Marsden, Charing Cross, St Thomas’, Broomfield and Queen Victoria Hospitals. The information was provided by a Consultant Microsurgeon in each case (Figure 1). All units were affected by the pandemic. The number of fellows employed by each hospital was between 2 and 6. In two units, the microsurgical fellows were relocated to assist with breast and colorectal oncology procedures. In all participating units, breast reconstruction services ceased in March, ranging from the 16th to the 23rd and the recovery plans have not been homogeneous. The Royal Marsden and Charing Cross Hospitals, have slowly restarted offering immediate breast reconstructions in the beginning of June, St Thomas’ and Broomfield hospitals by the end of June and Queen Victoria hospital by July. This reflects the different impacts the pandemic has had in the individual hospitals, which needs to be evaluated prior to elective procedures recommencing. The majority of the consultants felt that the fellows were unlikely to achieve their individual goals in microsurgery and programme extensions had been offered. A pleasant surprise during this period of crisis, was the upgrade of teaching reported in all units. As found in the recent literature, lockdown gave rise to virtual teaching which provided an accessible source of highly effective learning.5Sleiwah A. Mughal M. Hachach-Haram N. Roblin P. COVID-19 lockdown learning: the uprising of virtual teaching.J Plast Reconstr Aesthet Surg. 2020; (S1748-6815-X): 30214https://doi.org/10.1016/j.bjps.2020.05.032Abstract Full Text Full Text PDF Scopus (19) Google Scholar Finally, when asked how the negative impact on training could be mitigated, the answer was a combination of programme extensions and more structured webinar teaching opportunities. In conclusion, the impact of COVID-19 pandemic has been significant in microsurgical training. This study highlights the extent of the problem but demonstrates that supervising consultants are aware of this new reality. As microsurgery services resume globally, programme extensions and increased teaching, seem as the best way to compensate for the lost training opportunities. None.