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 Table of Contents  
EDIRORIAL
Year : 2020  |  Volume : 1  |  Issue : 2  |  Page : 73-74

COVID-19 and its impact on urology training: Going digital is the way forward


1 Department of Urology, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission26-Jun-2020
Date of Decision13-Jul-2020
Date of Acceptance08-Sep-2020
Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. C Danny Darlington
Department of Urology, Pondicherry Institute of Medical Sciences, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_114_20

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How to cite this article:
Darlington C D, Mammen RJ, Chaurasia SK, Navriya SC, Mammen KJ. COVID-19 and its impact on urology training: Going digital is the way forward. J Med Evid 2020;1:73-4

How to cite this URL:
Darlington C D, Mammen RJ, Chaurasia SK, Navriya SC, Mammen KJ. COVID-19 and its impact on urology training: Going digital is the way forward. J Med Evid [serial online] 2020 [cited 2021 Apr 13];1:73-4. Available from: http://www.journaljme.org/text.asp?2020/1/2/73/303547



The coronavirus disease 2019 (COVID-19) is rapidly spreading worldwide gaining a foothold and affecting every part of human life. The situation is no different in India where the disease has wreaked havoc in all services including healthcare. While healthcare workers are directly or indirectly affected by this widespread disease, the toll it has on the resident training is expected to be huge.[1] This requires attention considering that training a doctor is the rate-limiting step in the supply chain of COVID-19 care.[2]

Patient care has always been prioritised to teaching in times of public health crisis. As most of the elective services have been hit by the pandemic, urology being a predominantly elective field has been hit hard. Overall, most of the elective urological surgeries are deferred or delayed during the pandemic as priority is being given for emergency procedures and cancer surgeries. Hence, urology units will be expected to perform only emergent endourological procedures and select cancer services with senior urologists performing most of the procedures, considering the pandemic situation. Although a vast majority of the hospitals perform emergent endourological procedures (ureteroscopy, and cystoscopy, trans-urethral resection of bladder tumours) and other benign surgeries which residents can participate, the numbers are less compared to the pre-COVID era.[1]

Face-to-face undergraduate and postgraduate teaching sessions have been replaced by virtual online academic programs. Teaching grand rounds, case-based departmental discussions, journal clubs and multi-disciplinary tumour board meetings, uro-radiology, uro-pathology, uro-gynaecology and uro-nephrology inter-departmental meetings have been cancelled because of the risk of social gatherings and spread of the virus.[3] Residents being the frontline care providers are at increased risk of contracting the disease.[4] This creates psychological and mental stress due to the isolation and quarantine associated with the diagnosis. Cancellation of rotations and postings and delays in dissertations and examinations add further insult to the fire. Further, it is difficult to predict the duration of the COVID-19 pandemic in India which adds to the uncertainty of training the future urologists.

The data on the effect of COVID-19 on surgical training are sparse and limited to editorials and opinions. A questionnaire-based study conducted in Italy by Amparore et al. assessed the impact of the pandemic on urology training. Residents belonging to early years of training reported more than 80% reduction of their involvement in outpatient and diagnostic procedures during the pandemic. On the other hand, 42%–46% of 1st-year residents reported > 80% reduction of their role in endoscopic, open and minimally invasive surgeries during the pandemic.[5] On the contrary, the situation is different for fellowships where the duration is relatively short. Precious time available for the fellowship is curtailed due to the cancellation of surgeries, while the healthcare personnel are diverted to COVID-19 care. Hence, several guidelines suggest postponing or temporarily suspending surgical fellowships during the pandemic.[6]

Restructuring the residency programme to implement a curriculum to compensate for the lost training opportunities is the need of the hour in all surgical residency programmes including urology.[7] While the solutions discussed are specific for urology trainees, residency programmes in other surgical specialities can follow similar protocols to optimise resident training in the COVID era. First and foremost, the team should ensure good mental and physical health of the residents by arranging awareness programmes and discussions online regarding mental health during the pandemic. To maintain a healthy reserve of residents, many programmes rotate their residents for urology services. Clinical training in urology can also be promoted by encouraging resident participation in telehealth services and virtual grand rounds.[8] Journal clubs can be conducted online through various platforms available. For example, urology residents can make use of International Urology Journal Club – the first urology journal club in Twitter using the hash tag #urojc.[9] Residents should be encouraged to attend pre-recorded lectures and interactive webinars to further their clinical knowledge. Podcasts are viable alternatives for screen-fatigued residents.[1] Motivational activities such as team play activities, time management training, communication skills and lifestyle changes must be encouraged by the faculty and trainers to promote positive attitude amid the pandemic.

Although surgical techniques are best learnt in the operating room, there are several repositories of surgical videos worth watching for urology residents. The European Association of Urology has a well-established training 'Surgery in Motion School' – a video-based programme for surgical training. Webinars by experts on surgical tips and tricks can further provide avenues to improve one's surgical expertise. Webinars with interactive discussions also improve the non-technical skills required for future surgeons.[1] Simulators can be used to train urologists in laparoscopic and robotic procedures. However, it is extremely unlikely that high-fidelity simulators will be available during the pandemic. Hence, low-fidelity simulators such as the laparoscopic box trainers, which are easily available, can be encouraged.[8]

Conducting urological research in the times of COVID-19 is a challenging task which needs to be addressed urgently. The 'Basic Course in Biomedical Research' offered by the Indian Council of Medical Research-National Institute of Epidemiology, Chennai, is recommended for residents in training across the country from 2019.[10] Hence, residents should be encouraged to complete this course during the off-duty hours. The American Urology Association also has an online 'Research Overview' programme which can provide insights into urological research.[11] Every effort should be made to sustain quality urological research during the pandemic. A common platform can be established for residents from all over the country, enabling them to share data and experience, thereby fostering research.[8] Online and virtual pre-examination mock assessments can be held to augment the preparedness of the residents-in-training.

To sum up, while health systems scramble to contain the spread of the novel coronavirus, limited resources and a lesser number of surgeries during the pandemic cannot be an excuse for inadequate training of budding urologists. Although online education is the way forward, it should be thought of as a supplement to the actual training which occurs in the wards and operating rooms, even in times of COVID-19. It is imperative to follow-up the training of residents amidst the pandemic. This calls for an effective restructuring of residency programmes in the country. As every programme is unique, there is no common protocol for the betterment of training and local scenario and resources should guide these efforts. Good teamwork and interdepartmental support are keys to long-term success in these unprecedented times.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Porpiglia F, Checcucci E, Amparore D, Verri P, Campi R, Claps F, et al. Slowdown of urology residents' learning curve during the COVID-19 emergency. BJU Int 2020;125:E15-7.  Back to cited text no. 1
    
2.
Lodha R, Kabra SK. COVID-19: How to prepare for the pandemic? Indian J Pediatr 2020;87:405-8.  Back to cited text no. 2
    
3.
Chan MC, Yeo SE, Chong YL, Lee YM. Stepping forward: Urologists' efforts during the COVID-19 outbreak in Singapore. Eur Urol 2020; 78:e38-e39.  Back to cited text no. 3
    
4.
Chang , Xu H, Rebaza A, Sharma L, Dela Cruz CS. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med 2020;8:e13.  Back to cited text no. 4
    
5.
Amparore D, Claps F, Cacciamani GE, Esperto F, Fiori C, Liguori G, et al. Impact of the COVID-19 pandemic on urology residency training in Italy. Minerva Urol Nefrol 2020;72:505-9.  Back to cited text no. 5
    
6.
Professionals SO. EAU Robotic urology section (ERUS) guidelines during COVID-19 emergency. Uroweb 2020. Available from: https://uroweb.org/eau-robotic-urology-section-erus-guidelines-during- covid-19-emergency/. [Last accessed on 2020 May 31].  Back to cited text no. 6
    
7.
Weber AC, Henderson F, Santos JM, Spiotta AM. Letter: For whom the bell tolls: Overcoming the challenges of the COVID pandemic as a residency program. Neurosurgery 2020;87:E207.  Back to cited text no. 7
    
8.
Kwon YS, Tabakin AL, Patel HV, Backstrand JR, Jang TL, Kim IY, et al. Adapting urology residency training in the COVID-19 Era. Urology 2020;141:15-9. Available from: https://www.goldjournal.net/article/S0090-4295 (20) 30452-0/abstract. [Last accessed on 2020 May 30].  Back to cited text no. 8
    
9.
Thangasamy IA, Leveridge M, Davies BJ, Finelli A, Stork B, Woo HH. International urology journal club via twitter: 12-month experience. Eur Urol 2014;66:112-7.  Back to cited text no. 9
    
10.
Basic Course in Biomedical Research Course. Available from: https://swayam.gov.in/nd1_noc19_ge33/preview. [Last accessed on 2020 May 31].  Back to cited text no. 10
    
11.
Research Overview American Urological Association. Available from: https://www.auanet.org/research/research-overview. [Last accessed on 2020 May 31].  Back to cited text no. 11
    




 

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